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Menopause Overview

Women facing hereditary cancer have special considerations associated with early onset menopause and symptom management.

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Oophorectomy, Estrogen, and Dementia: A 2014 Update
Molecular and Cellular Endocrinology, published online February 10, 2014. Rocca, W.A., Grossardt, B.R., Shuster, L.T.

The effects of estrogen on the brain vary with age at the time of treatment. Estrogen naturally produced by the ovaries before age 50 years is neuroprotective. Estrogen treatment (ET) in early menopause may be neuroprotective (most commonly at ages 50–60 years). ET in late menopause (ages 65–79 years) is harmful regardless of the type of menopause. Women who experience premature or early menopause either naturally or after bilateral oophorectomy should receive ET.

Effect of Hormone Replacement Therapy on Cardiovascular Events in Recently Postmenopausal Women: Radomised Trial
BMJ: 345: e6409 (2012). Schierbeck, L.L, Rejnmark, L, Tofteng, C.L, et al.

Conclusion: After 10 years of randomized treatment, women receiving hormone replacement therapy early after menopause had a significantly reduced risk of mortality, heart failure, or myocardial infarction, without any apparent increase in risk of cancer, venous thromboembolism, or stroke.

The 2012 Hormone Therapy Position Statement of The North American Menopause Society
The North American Menopause Society, Menopause: The Journal of the North American Menopause Society 19: 257-271 (2012).

Conclusion: Recent data support the initiation of hormone therapy around the time of menopause to treat menopause-related symptoms and to prevent osteoporosis in women at high risk of fracture. The more favorable benefit-risk ratio for estrogen therapy (ERT) allows more flexibility in extending the duration of use compared to estrogen + progesterone (HRT) where the earlier appearance of increased breast cancer risk precludes a recommendation for use beyond 3 to 5 years.

Premature menopause or early menopause: long-term health consequences
Maturitas (European Menopause Journal), 2010 February; 65(2): 161. Shustere, LT, Rhodes, D, Gostout, B, Grossardt, B, Rocca, W,

Conclusion: Regardless of the cause, women who experience hormonal menopause and estrogen deficiency before reaching the median age of natural menopause are at increased risk for morbidity and mortality. Estrogen treatment should be considered for these women, but may not eliminate all of the adverse outcomes.

Effect of Short-Term Hormone Replacement Therapy on Breast Cancer Risk Reduction After Bilateral Prophylactic Oophorectomy in BRCA1 and BRCA2 Mutation Carriers: The PROSE Study Group
J Clin Oncol. 2005 Nov 1;23(31):7804-10. Timothy R. Rebbeck, Susan Domchek, Barbara L. Weber et. al.

Short-term hormone replacement after surgical menopause for women with BRCA mutations who have never had breast cancer does not increase breast cancer risk.

Safety and Efficacy of a Testosterone Patch for the Treatment of Hypoactive Sexual Desire Disorder in Surgically Menopausal Women
Archives of Internal Medicine, Volume 165 Number 14: p. 1582-1589, July 2005. Glenn D. Braunstein, Dale A. Sundwall, Molly Katz, Jan L. Shifren, John E. Buster, James A. Simon, Gloria Bachman, Oscar A. Aguirre, Johna D. Lucas, Cynthia Rodenberg, Akshay Buch, Nelson B. Watts.

Effect of Zolpidem on sleep in women with perimenopausal and postmenopausal insomnia: a 4-week, randomized, multicenter, double-blind, placebo-controlled study
Clinical Therapeutics, Volume 26, Issue 10: p. 1578-1586, October 2004.Cynthia M. Dorsey, Kathryn A. Lee, Martin B. Scharf.

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