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386 Current Topics in Menopause Stojanovska and Kitanovska
joint pain and backache [1]. In addition, estrogen deficiency increases the risk of
developing other more serious chronic conditions, including osteoporosis,
genitourinary atrophy, hypercholesterolemia and cardiovascular diseases [2].
Up to 80 percent of women around menopause experience some of these
menopausal symptoms, with hot flushes and night sweats, being the most
common ones [1, 3]. 10–20% of all women have nearly intolerable hot flushes.
Although a recent published data from a large observational study showed the
average duration of vasomotor symptoms was 5.5 years [4], some women may
have them for 10 years or longer [5, 6]. These menopause symptoms can be
menacing to cope with at the best of times and may decrease the quality of
women’s life [7].
Menopausal symptoms are common in all cultures but vary in individual
frequency, with American, British and Australian women reporting the highest,
and women from Asian countries reporting lowest frequency of vasomotor
symptoms, with joint paints being the most common symptoms is Asia [1, 8].
Recent data from SWAN study indicate that differences in body mass index may
be more important predictor of hot flushes than ethnic differences [9].
Hormonal replacement therapy (HRT) is currently the core treatment for shortterm
symptoms in menopausal women. Scientific data indicates that HRT is the
most effective treatment for reducing vasomotor symptoms, in particular hot
flushes [10-12]. Unfortunately there are many situations in which HRT has been
associated with side effects such as breast tenderness, bloating and breakthrough
bleeding [13]. Unfavourable results reported from large clinical trials, such as
HERS, WHI and Million Women Study, associated the long-term use of HRT
with increased risk of breast and ovarian cancers, stroke, coronary heart disease
and thromboembolic incidence [14-19]. Many expert groups recommend that
combination hormonal therapy for the management of vasomotor symptoms
should be limited to the shortest duration, consistent with treatment goals and
benefits versus risks for individual women.
Therefore the use of HRT has dramatically declined in the past decade and
women transitioning through menopause seek other safer treatments, such as