Menopause: When to Start
The traditional way of giving oestrogens for women after the menopause is to treat the characteristic climacteric symptoms with continuous oestrogens and the addition of cyclical progestogens for 10 or 12 days per month producing a withdrawal bleed or by continuous combined oestrogen/progestogen therapy with daily low dose progestogen as a non-bleed preparation.
However, there is often an indication to start therapy before the cessation of periods in women who have hormone responsive depression. This depression may be cyclical as in severe premenstrual depression or continuous with possible premenstrual exacerbations in the 2 or 3 years before the periods cease. It is very important to realise that climacteric depression is at its worst in these years when the woman is still having periods and therefore the association with a hormonal aetiology is not apparent. These women in fact do very well on a slightly higher dose of oestrogens, particularly in the form of patches, gels or implants with doses of 100 or even 200 mcgs of oestradiol patch twice weekly with cyclical oral progestogen is more effective than low dose oral therapy in this group of patients.