Abstract
Menopausal hormone therapy (HT) prescribing practices have evolved over the last few decades guided by the changing understanding of the treatment’s risks and benefits. Since the Women’s Health Initiative (WHI) trial results in 2002, including post-intervention analysis and cumulative 18-year follow up, it has become clear that the risks of HT are low for healthy women less than age 60 or within ten years from menopause. For those who are experiencing bothersome vasomotor symptoms, the benefits are likely to outweigh the risks in view of HT’s efficacy for symptom management. HT also has a role in preventing osteoporosis in appropriate candidates for treatment. A comprehensive overview of the types, routes, and formulations of currently available HT, as well as HT’s benefits and risks by outcomes of interest are provided to facilitate clinical decision making.
Highlights
Menopausal hormone therapy (HT) prescribing practices have evolved over the last few decades guided by the changing understanding of the treatment’s risks and benefits
During the intervention phase of the Women’s Health Initiative (WHI), the risks of pulmonary embolism (PE) and deep vein thrombosis (DVT) were significantly higher in the oral conjugated equine estrogens (oCEE) plus medroxyprogesterone acetate (MPA) group in the overall study population compared to placebo (HR:1.98 [95% CI:1.36-2.87] for PE, HR:1.87 [95%CI:1.37-2.54] for DVT)
A meta-analysis of 19 RCTs all using oral estrogens with or without a progestogen found that women who started HT fewer than 10 years after menopause and younger than 60 showed that it increased the risk of VTE compared to placebo, without differences by age group (RR: 1.74; 95% CI: 1.11-2.73) [13, 36]
Summary
Menopausal hormone therapy (HT) prescribing practices have evolved over the last few decades guided by the changing understanding of the treatment’s risks and benefits. Given the improved understanding of the risks and benefits of HT, organizations across disciplines have published guidelines supporting the initiation of HT for symptomatic women who are within 10 years of menopause and under age 60 and without contraindications, such as breast cancer or existing cardiovascular disease. These organizations include the North American Menopause Society (NAMS), the American College of Obstetricians and Gynecologists (ACOG), and the Endocrine Society [13,14,15]. The following review aims to provide a practical tool for healthcare professionals caring for menopausal women by discussing in detail various types and formulations of HT available as well as the risks and benefits of HT for common outcomes of interest in clinical practice
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