Vasomotor symptoms (VMS) are the hallmark of menopause across the globe (1, 2). 75% of women report some VMS (hot flushes and/night sweats) with nearly 30% of postmenopausal women younger than 55 years reporting moderate-severe symptoms (2, 3). The median duration of VMS has been estimated to be 4.5 years from the final menstrual period in women followed up to their mid 60’s (4). We have found a third of Australian women aged 65 to 79 years had persistent VMS. VMS are associated with poor wellbeing, depressive symptoms and lower self-reported work ability. Arthralgia and vulvo-vaginal atrophy (VVA) are important and persistent symptoms. Despite the high prevalence and bothersomeness of most menopausal symptoms, the use of effective therapies to alleviate symptoms remains low globally. Notably, VVA is undertreated despite safe, simple and effective therapies. In contrast, women are resorting to over-the-counter treatments which lack proven efficacy.
A range of effective menopausal hormone therapy options are now available to facilitate individualisation of formulation and dose. Amongst these are oral and non-oral estrogens, synthetic progestins and progesterone, tibolone and most recently estrogen combined with a selective estrogen receptor modulator. New international guideline re-inforce the need to individualise treatment and that duration of treatment should be consistent with the treatment goals of the individual(5).