Therapeutic Interventions in Menopause: An Integrative Analysis of the Effects on Climacteric and Cardiovascular Prevention

Abstract

Menopause is a physiological transition marked by the cessation of ovarian function and the sustained decline in estrogen levels, resulting in symptoms that significantly affect quality of life and increase the risk of cardiovascular morbidities. Hot flashes, sleep disturbances, mood changes, and genitourinary symptoms are among the most prevalent manifestations. In parallel, hypoestrogenism contributes to metabolic changes, such as endothelial dysfunction, increased visceral adiposity, and worsening lipid profile, favoring the progression of cardiovascular diseases. Menopausal hormone therapy (MHT) is the most effective treatment for vasomotor symptoms and, when initiated early, may offer cardiovascular benefits. However, there are associated risks, such as thromboembolism and breast cancer, especially outside the so-called "window of opportunity." Non-hormonal alternatives, such as selective serotonin and norepinephrine reuptake inhibitors (SSRIs/SNRIs), mind-body techniques, and selective estrogen receptor modulators (SERMs), offer safe options for women with contraindications to MHT. This study analyzed the effects of hormonal and non-hormonal therapies on the control of vasomotor symptoms and prevention of cardiovascular risk in postmenopausal women. An integrative literature review was conducted, based on the PICO strategy, with searches for studies published between 2014 and 2024 in the PubMed, BVS, and SciELO databases. The results indicate that MHT remains the gold standard for managing vasomotor symptoms, while non-hormonal approaches demonstrate moderate efficacy and greater applicability in specific clinical contexts. The management of menopause should be individualized, based on scientific evidence and risk assessment.