[Hormone therapy through changing times].

Area of Science:

• Reproductive Endocrinology
• Cardiovascular Health
• Geriatric Medicine

Background:

• Current guidelines limit hormone therapy (HT) to symptomatic menopausal women, excluding primary disease prevention.
• Established risks of oral HT include thrombosis, pulmonary embolism, and stroke, particularly in older women.
• The benefits versus risks of HT vary significantly based on age and menopausal stage.

Purpose of the Study:

• To review the current recommendations and risks associated with menopausal hormone therapy.
• To evaluate the suitability of HT for primary disease prevention.
• To determine optimal HT formulations based on patient profiles and risk factors.

Main Methods:

• Systematic review of recent studies on menopausal hormone therapy.
• Analysis of risk-benefit profiles for different patient demographics and HT formulations.
• Evaluation of systemic versus local therapy for menopausal symptoms.

Main Results:

• Hormone therapy is primarily indicated for menopausal symptom management, not for preventing conditions like coronary artery disease, osteoporosis, or depression.
• Oral hormone therapy poses elevated risks of thrombosis, pulmonary embolism, and stroke, especially in elderly women.
• Younger, early-menopausal women may experience greater benefits than risks from hormone therapy.
• Transdermal estrogen, combined with micronized progesterone for women with a uterus, is suggested for those with moderate to high cardiovascular risk.

Conclusions:

• Menopausal hormone therapy should be individualized based on symptom severity, patient preference, and risk assessment.
• Transdermal estrogen offers a potentially safer alternative for women with cardiovascular concerns.
• Further research is needed to clarify the role of HT in primary disease prevention.