Estrogen and alternative therapy of the menopausal patient.

Estrogen therapy is indicated for the vasomotor, genitourinary, and menstrual changes of the climacteric woman. Estrogens should be prescribed to relieve these symptoms specifically, and in the lowest dosage for the shortest time. Vaginal estrogens are appropriate in the treatment of genitourinary symptoms and may be given until sexual activity ceases. Vaginal ointments may be given even to patients in whom oral therapy may be contraindicated. Alternative therapy is helpful in the treatment of vasomotor symptoms, vulvitis, and breast tenderness. Appropriate therapy for all women includes a complete history and physical examination, and a thorough discussion of the physiologic and psychological changes of menopause. Appropriate studies include tests for estrogen effect to monitor therapy. They assist in treatment of the complexity of the menopause.