Management of menopausal hormone therapy

Area of Science:

• Reproductive Endocrinology
• Cardiovascular Health
• Gerontology

Background:

• Menopause significantly impacts women's health, necessitating effective management strategies.
• Hormone therapy has evolved, with ongoing research into its risks and benefits.

Purpose of the Study:

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

Main Methods:

• Review of recent studies, including reanalysis of the Women's Health Initiative.
• Synthesis of current evidence on cardiovascular disease (CVD), bone health, venous thromboembolism (VTE), and mood disorders.

Main Results:

• Estrogen demonstrates a protective role in CVD and bone health, especially when initiated before age 60.
• Transdermal estradiol and micronized progesterone formulations show no increased VTE risk compared to oral options.
• MHT may benefit perimenopausal and menopausal mood disorders, with potential cognitive and CVD benefits linked to the timing hypothesis.

Conclusions:

• Personalized risk assessment and shared decision-making 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.
• MHT is not currently recommended for primary prevention, though its role in preventive strategies is under investigation.