Management of menopausal hormone therapy

Area of Science:

• Reproductive Endocrinology
• Cardiovascular Health
• Gerontology

Background:

• Menopausal hormone therapy (MHT) is a common treatment for managing menopausal symptoms.
• Recent research has re-evaluated the risks and benefits of MHT, particularly concerning cardiovascular disease (CVD) and bone health.

Purpose of the Study:

• To offer practical guidance on managing menopausal hormone therapy.
• To update clinicians on the current understanding of MHT's risks and benefits.

Main Methods:

• Review of Women's Health Initiative (WHI) data.
• Analysis of recent clinical studies on MHT efficacy and safety.

Main Results:

• Estrogen demonstrates a protective effect on cardiovascular disease and bone health, especially when initiated before age 60.
• Oral MHT formulations are associated with increased venous thromboembolism (VTE) risk, whereas transdermal estradiol and micronized progesterone do not appear to elevate VTE risk.
• MHT may offer benefits for mood disorders during perimenopause and menopause, with the timing hypothesis potentially relevant for both CVD and cognition.

Conclusions:

• Individualized risk assessment and shared decision-making with healthcare providers are essential for managing symptomatic menopause.
• MHT is a safe and effective treatment for vasomotor symptoms in healthy women under 60 or within 10 years of menopause.
• Current major medical societies do not recommend MHT for primary prevention, although its role in preventive strategies is under ongoing investigation.