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Menopausal hormone therapy: Benefits and risks

INTRODUCTION

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 'Candidates/indications'.)

OVERVIEW

Menopausal hormone therapy (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 vaginal atrophy".)

Women's Health Initiative (WHI) — In the past, MHT was also often prescribed for prevention of coronary heart disease (CHD) and osteoporosis, based upon epidemiologic data demonstrating a protective effect of estrogen on the heart and bone. However, data from the WHI, a set of two hormone therapy (HT) trials (unopposed estrogen and continuous, combined estrogen-progestin therapy versus placebo) in approximately 27,000 postmenopausal women (mean age 63 years) showed a number of adverse outcomes, including an excess risk of CHD, stroke, venous thromboembolism (VTE), and breast cancer [2-4].

Similar results were noted in a meta-analysis of 23 trials [5], and an updated 2012 United States Preventive Services Task Force (USPSTF) meta-analysis of nine trials [6]. Both included the WHI, and the mean age of subjects was >60 years. In the USPSTF analysis, results were largely based upon the WHI. Based upon their current meta-analysis, the USPSTF continues to recommend against the use of both combined estrogen and progestin and unopposed estrogen (for women post-hysterectomy) for the prevention of chronic conditions [6,7]. However, they note that this recommendation does not apply to women considering using HT for relief of menopausal symptoms [7,8].

                                            

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Literature review current through: Sep 2014. | This topic last updated: Sep 9, 2014.
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