Many women experience troublesome symptoms around the climacteric, particularly vasomotor disturbances such as flushes and sweating, mood changes, insomnia, loss of libido, vaginal dryness and dyspareunia. Oestrogen replacement has become the treatment of choice for these symptoms and is also recommended for the prevention of postmenopausal bone loss in those at particular risk of developing osteoporosis.1,2 Given alone oestrogen may cause endometrial hyperplasia increasing the risk of cancer in women with an intact uterus. Including a progestagen for part of the cycle prevents this, but results in a withdrawal bleed.
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