Treatment of menopausal symptoms with hormone therapy

UpToDate®: Treatment of menopausal symptoms with hormone therapy: "A low-estrogen oral contraceptive (20 mcg of ethinyl estradiol) remains an appropriate treatment for perimenopausal women who seek relief of menopausal symptoms, and who also desire contraception, and in some instances need bleeding control (in cases of dysfunctional uterine bleeding). Most of these women are between the ages of 40 and 50 years and are still candidates for oral contraception. For them, an oral contraceptive pill containing 20 mcg of ethinyl estradiol provides symptomatic relief while providing better bleeding control than conventional estrogen-progestin therapy because the oral contraceptive contains higher doses of both estrogen and progestin (which suppresses the hypothalamic-pituitary-ovarian axis). In our practice, when women taking a low-dose oral contraceptive during menopause reach age 50 or 51 years, we discuss stopping the pill altogether, or changing to an estrogen replacement regimen if necessary for symptoms. If estrogen is then given, the same recommendations for use would apply (for management of symptoms but not for disease prevention). Because women at this age are apt to have hot flushes when estrogen is stopped abruptly, we recommend tapering the oral contraceptive by one pill per week as described for estrogen therapy."