Hormone Therapy For Menopause

Hormone therapy is the most effective treatment for vasomotor symptoms (VMS) and genitourinary syndrome of menopause (GSM) and has been shown to prevent bone loss and fracture. (Level I)

Benefits are most likely to outweigh risks for symptomatic women who initiate hormone therapy (HT) when aged younger than 60 years or who are within 10 years of menopause onset. (Level I)

Hormone therapy should be individualized, taking into account the indication(s) or evidence-based treatment goals, consideration of the woman’s age and/or time since menopause in relation to initiation or continuation, the woman’s personal health risks and preferences, and the balance of potential benefits and risks of HT versus nonhormone therapies or options. (Level III)

The risks of HT in the Women’s Health Initiative (WHI) and other studies differ overall for estrogen therapy (ET) and estrogen-progestogen therapy (EPT), with a more favorable safety profile for ET. (Level II)

Practitioners should use an appropriate HT type, dose, formulation, route of administration, and duration of use to meet treatment objectives, with periodic reassessment of changes in a woman’s health, and anticipated benefits, risks, and treatment goals over time. (Level III)

Assessment of risk for estrogen-sensitive cancers, bone loss, heart disease, stroke, and VTE is appropriate when counseling menopausal women. (Level III)

Decision making about HT should be incorporated into a broader discussion of lifestyle modification to manage symptoms and risks for chronic diseases of aging. (Level III)