Recent advances help understand and improve the safety of menopausal therapies.

Abstract

Hormone therapy (HT) remains a mainstay of treatment of vasomotor symptoms, which are among the most common and most bothersome of menopausal symptoms. This review provides updates on HT and reviews newer menopausal therapies, focusing on recent safety data. An interpretative review of recent medical literature was conducted using computerized databases. The latest analyses from the Women's Health Initiative and other trials suggest that there is a window shortly after the onset of menopause in which HT provides optimal benefit with minimal risk. Risks of breast cancer, coronary heart disease, and probable dementia increase when a progestin is included in the HT regimen, which is necessary in nonhysterectomized women to counter the proliferative effects of estrogens on the endometrium. Attempts to further optimize the risk-benefit profile of menopausal therapies have led to the introduction of newer selective estrogen receptor modulators (bazedoxifene for osteoporosis, ospemifene for dyspareunia), tissue-selective estrogen complexes (conjugated estrogens/bazedoxifene for vasomotor symptoms and osteoporosis), and non-HT (low-dose paroxetine for vasomotor symptoms). Recent studies suggest that HT has a neutral or even beneficial effect on coronary heart disease and cognition when used in the early postmenopausal years. The risk-to-benefit ratio of estrogen therapy in hysterectomized women is more favorable than that of estrogen-progestin regimens in nonhysterectomized women. Conjugated estrogens/bazedoxifene now provides a progestin-free option for managing vasomotor symptoms in postmenopausal women with an intact uterus. Low-dose paroxetine may be an alternative for some women when hormonal treatments are contraindicated.