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

Summary & key facts

Past large trials found that using combined estrogen and progestin was linked to higher heart-related risk, and hormone therapy (HT) use fell a lot afterward. In the last 20 years, research shows that when HT starts (age and time since menopause) and how it is given (route) affect heart disease risk. Four major medical societies now recommend HT for women with bothersome menopausal symptoms, and this expert review gives guidance on who and which HT formulations to consider, especially for symptomatic women with cardiovascular risk.

Key facts:

• Early primary and secondary prevention trials reported that combined estrogen-progestin therapy was associated with increased cardiovascular risk.
• Use of menopausal hormone therapy declined significantly after those trials showed higher heart-related risk.
• Over the past 20 years, research has found that timing of HT (a woman’s age and how long it has been since menopause) and the route of HT administration are related to cardiovascular disease risk.
• Four leading medical societies recommend hormone therapy for treating women with bothersome menopausal symptoms.
• This review was led by the American College of Cardiology’s Cardiovascular Disease in Women Committee together with gynecologists, women’s health internists, and endocrinologists, and it aims to provide guidance on selecting patients and HT

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)