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Menopausal hormone therapy: Benefits and risks

Kathryn A Martin, MD
Robert L Barbieri, MD
Section Editors
Peter J Snyder, MD
William F Crowley, Jr, MD
Deputy Editor
Kathryn A Martin, MD


Normal women have menopause at a mean age of 51 years, with 95 percent becoming menopausal between the ages of 45 to 55 years. Estrogen is the most effective treatment available for relief of menopausal symptoms, most importantly, hot flashes. Menopausal hormone therapy (MHT, estrogen alone or combined with a progestin) is currently indicated for management of menopausal symptoms.

An overview of the risks and benefits of MHT will be provided here. The management of women with hot flashes and other menopausal symptoms is reviewed in greater detail separately. (See "Menopausal hot flashes" and "Treatment of menopausal symptoms with hormone therapy", section on 'Choosing candidates'.)


MHT continues to play an important role in the management of hot flashes. It is highly effective for the management of hot flashes, vaginal atrophy, and, in some cases, the mood lability that many women experience during the menopausal transition [1]. Details on management of vasomotor symptoms are reviewed in detail separately. The use of vaginal estrogen for vaginal atrophy is also reviewed separately. (See "Treatment of menopausal symptoms with hormone therapy" and "Menopausal hot flashes" and "Treatment of genitourinary syndrome of menopause (vulvovaginal atrophy)".)

Individualized approach — The most recent clinical practice guideline published by the Endocrine Society presents an individualized approach to treatment based upon calculating a woman's baseline cardiovascular and breast cancer risks prior to initiating therapy (table 1) [2]. Similar to most other guidelines, the Endocrine Society agrees that MHT is indicated for the management of menopausal symptoms but not for the prevention of cardiovascular disease, osteoporosis, or dementia [3-6]. The benefits of MHT appear to outweigh its risks for most symptomatic women who are either under age 60 years or less than 10 years from menopause [2,4,5] (figure 1).

The approach to managing menopausal symptoms with MHT and nonhormonal alternatives is reviewed separately. (See "Menopausal hot flashes" and "Treatment of menopausal symptoms with hormone therapy".)

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Literature review current through: Nov 2017. | This topic last updated: Nov 28, 2017.
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