[Should the menopause be treated ? When and how? (author's transl)].

The premenopausal period is characterized by a luteal insufficiency which may be associated with spaniomenorrhea, mastodynia, and more rarely, vasomotor flushes. Therapy is based on the administration of progestogens which, taken from the 10the to the 25th day of the menstrual period act as affective contraceptive. After an artificial menopause by surgical castration, increased FSH levels are noted, together with a rapid reduction of plasma estrogen levels, and a secondary rise in LH levels. Therapy consists in giving ethinyl-estradiol for 25 days a month, together with a progestogen from the 15th to the 25th day of the cycle, after excluding cancer of the ovary, uterus, or breast. The natural menopause is often associated with vasomotor flushes, psychofunctional disorders, and occasionally with vulvovaginal atrophy. Usual therapy is based on the administration of estrogens or sequential estrogen-progestogen treatment. Close, regular medical watching is necessary, however, because of the risk breast or endometrical cancer, and vascular or lipid disorders.