Menopause

Menopause care is not a single prescription. It is a sequence of decisions: establish whether the symptoms fit the menopausal transition, identify a dangerous alternative or red flag, choose treatment for the symptom being addressed, and reassess prevention needs over time. Three targets commonly coexist: - Vasomotor symptoms (VMS): hot flushes and night sweats may require systemic menopausal hormone therapy (MHT), or evidence-supported nonhormonal treatment when hormones are contraindicated or declined. - Genitourinary syndrome of menopause (GSM): dryness, burning, dyspareunia, urinary discomfort, and urgency usually need regular local measures; this treatment pathway differs from treatment for VMS. - Long-term health: estrogen loss accelerates bone loss, while age and other risk factors shape cardiovascular and cancer-prevention care. Prevention alone is not a reason to prescribe systemic MHT indiscriminately. Before systemic estrogen, establish whether the uterus is intact and review bleeding, thromboembolic and arterial disease, breast or other estrogen-dependent malignancy, liver function, blood pressure, migraine, medications, and pregnancy possibility when relevant. A levonorgestrel-releasing intrauterine system may provide endometrial protection for a selected perimenopausal patient, but standard MHT is not contraception. Canadian prescribing...