Individualizing hormone-therapy according to cardiovascular risk

Many women, including those with risk factors for cardiovascular disease (CVD), may desire the benefits associated with hormone therapy including protection from progression of CVD, osteoporotic fractures, urogenital atrophy, skin loss, dementia, and a reduction in overall mortality. Before initiating or continuing therapy, it is important to consider an accurate risk benefit analysis in all women. Importantly, when considering initiation of hormone replacement, it is important to consider a woman's age, number of years since her menopause, and a number of cardiovascular risk factors. Women with positive risk factors are at increased risk for hormone therapy, especially related to the initiation of high dose oral therapy. Use of low dose transdermal hormone therapy can reduce these risks. For women with a recent cardiovascular event, current thromboembolic disease, long-standing immobilization, or severe peripheral arterial disease, hormone replacement is generally not recommended. There is growing consensus that the benefit to risk profile for hormone therapy is high for healthy, low-risk women initiating therapy within 10 years of menopause or under age 60. However, special considerations are needed for women who are outside those boundaries or for those that have risk factors for cardiovascular disease.