Rethinking Menopausal Hormone Therapy: For Whom, What, When, and How Long?

Area of Science:

• Cardiovascular Medicine
• Women's Health
• Endocrinology

Background:

• Past concerns over cardiovascular risk with combined hormone therapy (HT) led to decreased use.
• Recent research has refined understanding of HT's cardiovascular impact based on timing, route, and patient factors.
• Leading medical societies now recommend HT for managing menopausal symptoms.

Purpose of the Study:

• To provide updated guidance on menopausal hormone therapy (HT) use.
• To focus on patient selection and formulation for women with cardiovascular disease (CVD) risk.
• To address the needs of symptomatic women experiencing menopausal symptoms and CVD risk.

Main Methods:

• Review of current scientific literature on hormone therapy and cardiovascular disease.
• Analysis of data regarding timing of initiation, route of administration, and HT formulation.
• Consensus-based recommendations developed by a multidisciplinary expert committee.

Main Results:

• The relationship between HT, timing of use, and cardiovascular risk is complex and individualized.
• Specific HT formulations and routes of administration may have differential effects on cardiovascular outcomes.
• HT can be safely considered for select symptomatic menopausal women, particularly when initiated closer to menopause.

Conclusions:

• Menopausal hormone therapy (HT) can be a valuable treatment option for bothersome menopausal symptoms.
• Careful patient selection, considering age, time since menopause, and cardiovascular risk factors, is crucial.
• Personalized HT strategies, including formulation and route, are essential for optimizing benefits and minimizing risks in women with cardiovascular considerations.