Hormone replacement therapy

Abstract

Menopause is a physiologic event defined by the loss of ovarian follicular function and the final menstruation period. The average age of menopause has been remarkably stable over time and varies little between ethnic groups. Menopause is considered natural when it occurs spontaneously after the age of 45 years. It is surgical when the ovarian insufficiency results from bilateral oophorectomy (BO) or iatrogenic by chemotherapy or pelvic radiation when it occurs in a woman of childbearing age. Menopause is described as early when it occurs in women aged 40 to 45 years. It must be differentiated from premature ovarian failure (POF), which occurs before the age of 40. The perimenopause or menopausal transition is the period of about 4 years that begins with the decrease in fertility, alterations of the menstrual cycle and endocrinological changes and culminates with the last menstruation. The climacteric is the period that covers from the menopausal transition to the first post menopausal years¹. Menopausal replacement therapy (MRT) is used in women younger than 60 years and/or within 10 years of the onset of menopause and is approved for four indications: moderate to severe vasomotor symptoms (VMS); treatment of osteoporosis in early postmenopausal women; POF of any etiology and treatment of genitourinary syndrome (GUS) for which local treatment is suggested².

While MRT reduces the incidence of new-onset type 2 diabetes mellitus (DM), it is not approved for primary prevention³. MRTis not contraindicated in otherwise healthy women with preexisting type 2 DM with moderate to severe VMSand/or GUS and may be beneficial in terms of glycemic control when used for menopause symptom management. But, prior to starting MRT, it is essential to evaluate the risk factors for cardiovascular disease (RFCVD) The age of the patient, the time of her menopause and the presence or not of RFCVD will determine its use^1-2. If the woman with DM presents moderate to severe RFCVD and VMS, which contraindicates MRT, non-hormonal therapy should be considered, since VMS has a negative impact on well-being and health expectations⁴. Due to the complexity of menopause in a woman with diabetes, it is necessary to consider a transdisciplinary team before starting treatment.