39. 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 menstrual disorders, mood swings, joint problems, urovaginal symptoms, mental health problems, sleeping and sexual disorders may also 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 outweigh 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. For all women after menopause, healthy ageing and prevention of chronic diseases is of the essence. Thus a life course approach is important to be able to proactively take preventive measures for chronic diseases with high morbidity and mortality risk, such as gender specific cardiovascular diseases, mental health disorders and osteoporosis.