Current recommendations: what is the clinician to do?

Area of Science:

• Reproductive Endocrinology
• Women's Health
• Clinical Pharmacology

Background:

• Menopausal hormone therapy (HT) is used for vasomotor and other menopausal symptoms.
• Balancing benefits and risks of HT is essential for rational clinical use.
• The Women's Health Initiative (WHI) and other trials have informed HT benefit-risk understanding.

Purpose of the Study:

• To clarify the benefits and risks of menopausal hormone therapy.
• To identify clinical characteristics that predict favorable HT outcomes.
• To present an approach for personalized HT decision-making.

Main Methods:

• Analysis of findings from the Women's Health Initiative (WHI) and other randomized clinical trials.
• Evaluation of age, time since menopause, and other clinical factors as predictors of HT outcomes.
• Review of risk stratification and personalized risk assessment for HT.

Main Results:

• Younger women (50-59) using conjugated equine estrogens (CEE) alone showed more favorable mortality and myocardial infarction rates.
• Risks of stroke and venous thrombosis were observed across age groups for CEE + medroxyprogesterone acetate.
• Absolute risks of adverse events were lower in younger women compared to older women.

Conclusions:

• Age and time since menopause are key factors in assessing HT benefits and risks.
• Personalized risk assessment, considering patient characteristics and preferences, can optimize HT safety.
• Systemic HT should be initiated for moderate to severe menopausal symptoms, with regular re-evaluation.