The transition into menopause is a pivotal phase in a woman's life, demanding tailored care to prevent health complications and enhance overall well-being. “This is the perfect opportunity for a comprehensive health evaluation,” emphasized Professor Florence Trémollières from the Centre hospitalier universitaire de Toulouse, France, during the Pari(s) Santé Femmes congress held from 12-14 June 2024, in Paris.

Oestrogen depletion during this period may exacerbate numerous conditions, including cardiovascular issues, osteoporosis, and even certain types of cancer. “A thorough initial consultation should explore personal and family medical history, consider risk factors, existing treatments, lifestyle choices—such as hygiene, diet, exercise habits, smoking cessation—and evaluate functional symptoms, including genitourinary syndrome of menopause (GSM),” noted Trémollières. The consultation must also include fundamental physical, gynaecological, and breast examinations to assess overall health.

Cardiovascular Risk Assessment

Numerous cardiovascular risks tied to reproductive health often remain under-recognized:

Complementary Examinations

Oncological Screening Considerations

Regular cancer screenings, such as mammography, play a key role in detecting early warning signs. Breast screening not only identifies irregularities but also assesses breast tissue density and the presence of calcifications. “Research indicates that denser breast tissue is directly linked to higher breast cancer risk,” Trémollières elaborated. Additionally, the presence of calcifications may signal an increased risk for coronary artery disease. “It is vital to evaluate your mammograms thoroughly, beyond reading just the radiologist's report,” she stressed. “Similarly, bone density scans deserve careful scrutiny.”

In terms of preventive measures, incorporating a balanced diet, halting smoking, and practicing regular physical activities, like walking, are indispensable for maintaining health.

Menopausal Hormonal Therapy: Why, When, and How?

Menopausal Hormone Therapy (MHT) is widely regarded as the most effective solution for mitigating menopausal symptoms, improving life quality, addressing GSM when other symptoms are present, and preventing bone deterioration. “Even women with minimal bone-related risks experience a significant reduction in fracture rates when they commence hormone therapy in the initial five years post-menopause,” shared Trémollières. She also noted, “Starting MHT before the age of 60 has the added benefits of lowering cardiovascular mortality and overall mortality.”

MHT should be considered post-menopause, usually a year after the cessation of menstruation (amenorrhea), and should not extend beyond the first decade of menopause. Administering 17-beta-oestradiol transdermally is the preferred method, as it removes the potential risks of venous thromboembolism and stroke. “This method ensures the safest profile, though oral alternatives are acceptable if the patient is free from cardiovascular risks.” Clinical evidence also supports the combination of 17-beta-oestradiol with micronised progesterone or dydrogesterone for no less than 12 days every month. This combination “presents the most balanced option in terms of cardiovascular safety, minimising thrombotic and breast cancer risks.” Alternatively, systemic progestins can be substituted with a progesterone-releasing intrauterine device.

Certain special considerations, such as individuals previously treated for breast cancer or those who have undergone a hysterectomy, require personalized adjustments in alignment with clinical practice guidelines set by the National College of French Gynaecologists and Obstetricians.

This article was adapted from Univadis France using various editorial tools, including AI, with final checks performed by human editors before publication.

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