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

Summary & key facts

This paper is a clinical review about menopausal hormone therapy (HT). It explains that HT use fell after large prevention trials found higher cardiovascular risk with combined estrogen-progestin. In the last 20 years researchers have learned that a woman’s age, how long she has been menopausal, and the way HT is given can change heart risk. Four major medical societies now recommend HT for women who have bothersome menopausal symptoms. The review offers guidance on which patients and formulations to consider, with attention to women who have cardiovascular disease risk.

Key facts:

• Large prevention trials of the past reported an excess cardiovascular risk with combined estrogen-progestin, and that finding led to a big drop in HT use.
• Over the past 20 years, research has shown that timing of HT (age and time since menopause) and the route of administration can affect cardiovascular disease risk.
• Four leading medical societies recommend using HT to treat women who have bothersome menopausal symptoms.
• This article is a review led by the American College of Cardiology’s Cardiovascular Disease in Women Committee and includes input from gynecologists, women’s health internists, and endocrinologists.
• The review focuses on practical guidance: selecting which patients might receive HT and choosing HT formulations, with special attention to women who have cardiovascular disease risk.

Abstract

Menopausal hormone therapy (HT) was widely used in the past, but with the publication of seminal primary and secondary prevention trials that reported an excess cardiovascular risk with combined estrogen-progestin, HT use declined significantly. However, over the past 20 years, much has been learned about the relationship between the timing of HT use with respect to age and time since menopause, HT route of administration, and cardiovascular disease risk. Four leading medical societies recommend HT for the treatment of menopausal women with bothersome menopausal symptoms. In this context, this review, led by the American College of Cardiology Cardiolovascular Disease in Women Committee, along with leading gynecologists, women's health internists, and endocrinologists, aims to provide guidance on HT use, including the selection of patients and HT formulation with a focus on caring for symptomatic women with cardiovascular disease risk.

Topics

Estrogen and related hormone effects Menopause: Health Impacts and Treatments Phytoestrogen effects and research

Categories

Endocrinology, Diabetes and Metabolism Health Sciences Medicine

Tags

Biology Breast cancer Cancer Clinical trial Context (archaeology) Disease Estrogen Gynecology Hormone replacement therapy (female-to-male) Hormone therapy Intensive care medicine Internal medicine Medicine Menopause Paleontology Progestin Testosterone (patch)