Hormone Therapy For Menopause
Prevention of bone loss
The genitourinary syndrome of menopause/Vulvovaginal atrophy
Hormone therapy: type, dose, regimen, and duration of use
Type, dose, and regimen
- For women with a uterus using systemic estrogen, endometrial protection requires an adequate dose and duration of a progestogen or use of the combination CEE with bazedoxifene.
- Progestogen therapy is not recommended with low-dose vaginal ET, but appropriate evaluation of the endometrium should be performed if vaginal bleeding occurs, given the limits of safety data.
Duration of use
Discussions of duration of therapy should account for the woman’s health risks and the more favorable safety profile of CEE alone compared with the CEE + MPA seen in the WHI overall cohort.
- Decision making about HT duration should take into account the woman’s risk (personal or familial) of breast cancer, CHD, VTE, and stroke.
- There is more flexibility for duration of ET use because reduced incidence of breast cancer was found with CEE in the WHI and seen with estradiol in the less-powered, openlabel Danish Osteoporosis Prevention Study. This reduced effect has not been shown in all other observational studies, and some show increased risk with long duration of use.
- For EPT, discussions of duration should include information about the potential of increased (rare) risk of breast cancer (absolute risk < 1 additional case/1,000 person-years of use) that began after 3 years of standard-dose CEE þ MPA in the WHI. This increased risk was not seen in the subanalysis of the cohort without prior use of HT but was seen in past users. An increased risk of breast cancer over time has not been observed uniformly in other (less-powered) RCTs of HT using various EPT regimens.
- Discussion of benefits and risks of HT should include heart disease and all-cause mortality, particularly the reduced risk if started in women aged younger than 60 years or within 10 years of menopause onset and greater risks if initiated further from menopause onset or in women aged 60 years and older.
- Prevention of bone loss and fracture may be an indication for extended duration in select women after appropriate counseling about benefits and risks,
- recognizing that rapid bone loss is seen on discontinuation, but no rebound increase in fracture.
- Benefits and risks after withdrawing HT require consideration when deciding duration of therapy.
Women who are BRCA-positive without breast cancer
Breast and endometrial cancer survivors—systemic or vaginal hormone therapy
Bothersome VMS—consideration of systemic HT
Bothersome GSM symptoms—consideration of lowdose vaginal ET
Hormone Therapy For Menopause
July 1, 2017
Last Updated Month/Year
June 6, 2023
External Publication Status
Country of Publication
Female, Adult, Older adult
Health Care Settings
Ambulatory, Hospital, Outpatient
Nurse, nurse practitioner, physician, physician assistant
Assessment and screening, Diagnosis, Management, Treatment
D008593 - Menopause, D017698 - Postmenopause
breast cancer, estrogen, cardiovascular disease, menopause, hormone therapy, cognition, vaginal atrophy, vasomotor symptoms, Breast Cancer