Dr Ray O\u2019Connor continues his roundup of recent papers on the menopause, particularly HRT and quality of life, and any non-hormonal treatments for menopause symptoms<\/p>\n<\/p><\/div>\n
Menopause is a major health milestone for women who, statistically, will spend almost two-fifth of their life after menopause. A series of menopausal symptoms occur during menopausal transition, including vasomotor symptom (VMS, included hot flashes, and sweating). Here I look at some recent papers on menopause symptom management focusing on use of medication.<\/p>\n
HRT and quality of life<\/strong> Menopausal symptoms were recorded at screening and at 4, 12, and 24 weeks post-randomization. Menopausal symptoms were evaluated using the Menopause-Specific Quality of Life (MENQOL) questionnaire. Results were as follows.<\/p>\n Dr Ray O\u2019Connor<\/p>\n<\/div>\n Significant improvements of MENQOL scores were observed in both groups compared with baseline. The decrease of MENQOL scores after treatment showed almost no difference between the two groups (p > 0.05) except the VMS domain which indicated a better result in oral oestrogen group after 24 weeks. The authors concluded that both transdermal and oral oestrogens were highly effective in relieving the overall menopausal symptoms for recently-menopausal women, with little difference in treatment efficacy between the two routes.<\/strong><\/p>\n Menopause hormone therapy (MHT) and venous thromboembolism (VTE) risk<\/strong> Studies were heterogeneous in their definition of menopause, dose, form and route of administration of MHT, and the underlying VTE risk factor being assessed. The findings were that in women with risk factors for VTE, transdermal oestrogen conferred no increased risk of VTE. Oral oestrogen alone has the next safest profile, and oral oestrogen plus a progestogen conferred the highest increased risk of VTE. <\/strong>The authors concluded that transdermal MHT appears safe in women with risk factors for VTE. Oral MHT, notably oral oestrogen plus a synthetic progestogen, does increase relative risk. More contemporary data are required to confirm these findings.<\/strong><\/p>\n MHT and dementia<\/strong> Eligible primary studies included randomised controlled trials, nonrandomised intervention studies, and prospective observational studies examining the association between MHT\u2014including oestrogen-only MHT, combined MHT, testosterone, and tibolone\u2014and incident mild cognitive impairment or dementia.<\/p>\n Of 5,914 records, ten studies (one RCT and nine observational studies) with a total of 1,016,055 participants were included. Certainty of evidence ranged from moderate to very low. No included studies examined testosterone or use in premature ovarian insufficiency. No significant association was found between MHT use and risk of mild cognitive impairment or dementia<\/strong>. Subgroup analyses by timing, duration, and type of MHT showed no significant effects. <\/strong>The authors\u2019 concluded that their review found no evidence that MHT use either increases or decreases the risk of dementia in postmenopausal women.<\/strong><\/p>\n This reinforces current clinical guidance, that MHT prescription should be based on other perceived benefits and risks and not for dementia prevention. The authors recommend that high-quality, long-term studies are needed to clarify the role of MHT and dementia risk, particularly regarding formulation, dose, route, timing, and duration of treatment, with a focus on women with premature ovarian insufficiency, early menopause, or mild cognitive impairment.<\/p>\n Impact of MHT and exercise on bone mineral density (BMD)<\/strong> Both MHT and exercise are shown to improve BMD, with MHT reducing bone resorption and exercise promoting bone formation. This scoping review4<\/span> examined the effectiveness of MHT, exercise, and their combination in managing menopausal osteoporosis. Initial searches identified 15,158 studies, narrowed to 20 meeting the inclusion criteria. The findings were that MHT and exercise are effective in preserving BMD in menopausal women.<\/p>\n Combined oestrogen and progesterone MHT is more effective than oestrogen-only, with studies suggesting that MHT prescribed at low doses for longer durations more effectively preserves BMD. Resistance training (RT) completed 2\u20133 days per week at a moderate-to-high intensity combined with impact activity completed at a minimum of three days per week is optimal for improving BMD in menopausal women, while low-impact exercises provide supplemental benefits.<\/p>\n Combining MHT with exercise enhances BMD more than either alone. The authors concluded that combining MHT and structured exercise is most effective for enhancing BMD in menopausal women. Given certain safety considerations surrounding MHT in some women, exercise remains a cornerstone for the prevention and management of osteoporosis as well as for promoting overall wellness.<\/strong><\/p>\n Non-hormonal treatments for menopause symptoms<\/strong> Fezolinetant is a neurokinin 3 receptor antagonist that works by blocking the nerve pathways in the brain that trigger vasomotor symptoms. A 45 mg tablet is taken once a day.<\/p>\n A randomised trial on a similar drug has just been published.6<\/span> It was funded by the drug\u2019s manufacturer Bayer. Elinzanetant is a dual neurokinin-targeted therapy. This was a short 12 week study on 313 individuals. The authors concluded that Elinzanetant shows promise as a treatment for moderate to severe VMS. Further studies are ongoing.<\/p>\n References:<\/strong><\/p>\n Dr Ray O\u2019Connor continues his roundup of recent papers on the menopause, particularly HRT and quality of life, and any non-hormonal treatments for menopause symptoms Menopause is a major health milestone for women who, statistically, will spend almost two-fifth of their life after menopause. A series of menopausal symptoms occur during menopausal transition, including vasomotor […]<\/p>\n","protected":false},"author":1,"featured_media":76823,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_daextam_enable_autolinks":"","jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[2],"tags":[],"class_list":["post-76822","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/diyhaven858.wasmer.app\/wp-content\/uploads\/2026\/04\/GettyImages-2205818793-HRT-620.webp.webp","jetpack_sharing_enabled":true,"jetpack-related-posts":[],"_links":{"self":[{"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/posts\/76822","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/comments?post=76822"}],"version-history":[{"count":0,"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/posts\/76822\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/media\/76823"}],"wp:attachment":[{"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/media?parent=76822"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/categories?post=76822"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/tags?post=76822"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
The objective of this randomised trial1<\/span> was to compare the efficacy of oral and transdermal oestrogens in improving the quality of life in perimenopausal and recently postmenopausal women. Two hundred and fifty-seven women aged 40-55 years, within three years after their final menstrual period were randomized to receive transdermal oestrogel (t-E2) (n = 128) or oral oestradiol valerate (o- E2V) (n = 129; both with micronized progesterone 200 mg for 14 days each month).<\/p>\n![\"Dr](\"https:\/\/d1l0gza1nowsqe.cloudfront.net\/wp-content\/uploads\/sites\/4\/2022\/03\/Dr_ray_o_Connor_100.jpg\")
<\/p>\n
Studies have shown that oral oestrogen with or without progestogen increases the risk of venous thromboembolism (VTE). Recent data suggest that transdermal oestrogen confers little to no increased risk of VTE. This systematic review2<\/span> aimed to summarize the evidence on menopause hormone therapy (MHT) use in women with risk factors for VTE. The OVID Medline, Embase, PubMed and CENTRAL online databases were searched. A total of 762 studies were screened and 10 were included in the study. Six studies were case\u2013control studies, two were randomized controlled trials (RCTs), one was an RCT that contained a nested case\u2013control study and one was a cohort study.<\/p>\n
Globally, dementia disproportionately affects women. Changes in circulating sex steroids over the menopause transition might contribute to this sex difference. MHT is recommended by the UK National Institute for Health and Care Excellence to manage menopausal symptoms, but whether MHT use affects dementia risk and how this association might vary by age at menopause is unclear. The aim of this systematic review3<\/span> was to assess whether MHT (vs no MHT) affects the risk of mild cognitive impairment or dementia in peri-menopausal or post-menopausal women, including those with premature ovarian insufficiency or early menopause (with normal cognition or mild cognitive impairment), and whether MHT type, duration, or age at initiation influence this risk.<\/p>\n![\"\"](\"https:\/\/d1l0gza1nowsqe.cloudfront.net\/wp-content\/uploads\/sites\/4\/2025\/08\/link_box-you-might25.jpg\")
The authors systematically searched MEDLINE via OVID, Embase via Elsevier, Cochrane via OVID, and PsycINFO via OVID for systematic reviews published between Jan 1, 2000, and Dec 19, 2024. As no existing review met the quality or scope criteria, the authors then proceeded to conduct a systematic review and meta-analysis of primary studies published from Jan 1, 2000, to Oct 20, 2025.<\/p>\n
Osteoporosis, a condition marked by low bone mineral density (BMD) and structural deterioration, affects more women than men over 50 globally. In women, declining oestrogen during the menopause accelerates bone resorption, heightening fracture risk. An association between osteoporosis and depression, frailty fractures and poor quality of life has been identified.<\/p>\n
A recent report in the BMJ5<\/span> describes a new non-hormonal daily pill for menopausal hot flushes and night sweats can now be prescribed on the NHS when MHT is not suitable. Fezolinetant (Veoza, made by Astellas Pharma) has been recommended by the National Institute for Health and Care Excellence (NICE) to treat moderate to severe vasomotor symptoms caused by menopause.<\/p>\n\n
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