Menopause therapy: from classical consensus to new evidence

Abstract

Currently, the number of women who spend at least one third of their lives after menopause has increased exponentially, bringing about biological changes that impact personal, environmental, and cultural dimensions. Natural menopause usually occurs between the ages of 45 and 55, whereas induced menopause results from surgical interventions or treatments that impair ovarian function. This stage is characterized by decreased estrogen levels—particularly estradiol—and a consequent rise in follicle-stimulating hormone (FSH). The STRAW system classifies the different phases of the menopausal transition, from the reproductive stage to post menopause. Most women experience symptoms such as hot flashes, night sweats, mood changes, sleep disturbances, decreased libido, cognitive difficulties, increased cardiovascular risk, and genitourinary symptoms. Hormone therapy remains the most effective treatment, especially in women with moderate to severe symptoms, if contraindications are respected and cardiovascular risk is assessed using tools such as the ASCVD risk score. This therapy can be administered in low doses of estrogen, combined with progestogens in women with an intact uterus, and through various formulations—oral, transdermal, or topical. In addition, non-hormonal alternatives, both pharmacological and complementary, are available. Treatment choice should be based on an individualized assessment, considering risks, benefits, and patient preferences, with the goal of improving quality of life and reducing complications associated with cardiovascular risk and bone mass loss.