Editorial

Menopausal medicine and hormone therapy (HT), as its main product, has gone through periods of euphoria in the last 60 years when hormone therapy was presented "as an elixir of eternal youth," only for depression to quickly follow due to contraindications or side effects.All the good things that observational studies presented, have been questioned by randomized, placebo-controlled studies (RCT).How is this possible?Did the observational studies offer biases, or were the randomized studies poorly designed, conducted on the wrong population of women?Is oral HT the right choice, or would transdermal administration be better, with fewer side effects and better relative risks and hazard ratios?These are all questions that remain open, although re-analyses of individual RCT studies have offered answers and acknowledged the errors that, over many years, have reduced the prevalence of HT from 35% before 2002 to the current 4%.All of this has reduced the quality of life for millions of perimenopausal and postmenopausal women, reduced the preventive possibilities of HT, especially for cardiovascular diseases, osteoporosis, and the decline of cognitive functions that come with aging.Hormone therapy is certainly not the only possibility, but it does help women in menopause, as estrogen, progesterone, and testosterone receptors are spread throughout a woman's body, and menopause ceases all the good effects on the skin, bones, joints, hair, nails, libido, and the vaginal ecosystem, all of which drastically reduces the quality of life in postmenopause.Vasomotor symptoms are 62% responsible for seeking medical help.On the other hand, 11% of women should not use HT due to clear contraindications, and over 60% of women do not opt for HT regardless of indications.Therefore, it is necessary to approach women in menopause in a complementary way.For the treatment of urogenital atrophy, in addition to local estrogen, we can use laser or radiofrequency; for the treatment of atrophic lichen sclerosus, instead of corticosteroid creams and ointments, we now use treatment with platelet-rich plasma (PRP).Urinary incontinence occurs in over 40% of women over 60 years of age, so mild to moderate stress incontinence can be treated with laser or radiofrequency, and an overactive bladder together with urge incontinence, in addition to antimuscarinics and beta-3 agonists, with radiofrequency.For the treatment of vasomotor symptoms, we now have a great alternative in NK-3 blockers of the thermoregulation center in the hypothalamus, which opens up new possibilities for women after breast cancer.Adding testosterone to women with hypoactive sexual desire disorders (HSDD) raises the issue of FDA approved testosterone therapy in doses appropriate for women.Namely, titration of testosterone doses appropriate for women is generally based on 1/10 of the male testosterone dose, which in practice often compromises the decision to add testosterone to women.After more than two decades of fear and misinformation surrounding hormone replacement therapy (HRT), on November 10th, the U.S. Food and Drug Administration (FDA) is initiating the removal of broad "black box" warnings from HRT products for menopause.Randomized studies show that women who initiate HRT within 10 years of the onset of menopause (generally before age 60) have a reduction in all-cause mortality and fractures.Women may also reduce their risk of cardiovascular diseases by as much as 50%, Alzheimer's disease by 35%.Today, after all the cyclical periods related to HT, we know that HT can be taken lifelong, taking into account the "window of opportunity" related to the early start of hormone intake.Certainly, the complementarity of different therapies is the future for improving the quality of life for women in postmenopause.