27. The menopause, the perimenopause and the postmenopause

Menopause is a transition phase. Four out of five women experience some kind of discomfort and one third of these women experience serious complaints. Vasomotor symptoms are the most common complaints, but also menstrual disorders, mood swings, joint problems, urovaginal symptoms, or sexual disorders may occur. For these women the menopause has a serious impact on quality of life and consecutively societal consequences. Several treatment options are available. To date there is overwhelming scientific evidence that the benefits overweigh the risks of menopausal hormonal therapy (MHT). In the past, following the WHI study risks have been overrated or incorrectly interpreted. It is of importance that prescribing MHT should be individualised, based on the type of complaints, individual preferences and risks. Non-hormonal alternatives are available but merely not evidence-based, less effective and not always safe. For all women after menopause, healthy aging and prevention of chronic diseases is of the essence. Thus a life course approach can be of importance to make it possible to anticipate and so take prevention measures for chronic diseases with high morbidity and mortality risk, such as gender specific cardiovascular diseases and osteoporosis.