What to watch with CYP2C19 and Wechseljahre?

CYP2C19 is a key drug-metabolizing enzyme in the liver, responsible for breaking down several medications commonly used during menopause, such as certain SSRIs (citalopram, escitalopram, sertraline) and proton pump inhibitors (omeprazole, pantoprazole). Genetic variants (*2, *3, *17) can classify individuals as poor, intermediate, normal, or ultrarapid metabolizers. In menopause, hormonal fluctuations may further alter drug metabolism, potentially affecting efficacy and side effect risk. A CYP2C19 genetic test can guide personalized dosing, but it is not a standalone diagnostic tool. The evidence for routine testing in menopause is limited to mechanistic and case-based data; large clinical trials are lacking. Important caveats: drug-drug interactions (e.g., with hormone therapy) are not fully understood, and lifestyle factors also play a role. Always discuss test results with a healthcare provider who can integrate them into a comprehensive treatment plan. Evidence level: mechanistic/unclear.