Preparations for menopausal hormone therapy
- Kathryn A Martin, MD
Kathryn A Martin, MD
- Senior Deputy Editor — UpToDate
- Deputy Editor — Endocrinology and Patient Education
- Assistant Professor of Medicine
- Harvard Medical School
- Robert L Barbieri, MD
Robert L Barbieri, MD
- Editor-in-Chief — Obstetrics, Gynecology and Women's Health
- Section Editor — General Gynecology and Female Reproductive Endocrinology
- Kate Macy Ladd Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- Section Editors
- Peter J Snyder, MD
Peter J Snyder, MD
- Editor-in-Chief — Endocrinology
- Section Editor — Pituitary Disease; Male Reproductive Endocrinology
- Professor of Medicine
- University of Pennsylvania School of Medicine
- William F Crowley, Jr, MD
William F Crowley, Jr, MD
- Section Editor — Female Reproductive Endocrinology
- Daniel K Podolsky Professor of Medicine
- Harvard Medical School
The benefits of menopausal hormone therapy (MHT) outweigh the risk for healthy, symptomatic women who are within 10 years of menopause or younger than age 60 years and who do not have contraindications to MHT (such as a history of breast cancer, coronary heart disease [CHD], a previous venous thromboembolic event or stroke, or active liver disease).
This topic will review the available estrogen and progestin preparations, as well as other types of hormone preparations. An overview of the risks and benefits of MHT, treatment of menopausal symptoms with MHT (including choice of therapy), nonhormonal treatment options, and the use of estrogen in women with early menopause (primary ovarian insufficiency [POI]) are reviewed separately. (See "Menopausal hormone therapy: Benefits and risks" and "Treatment of menopausal symptoms with hormone therapy" and "Menopausal hot flashes" and "Management of spontaneous primary ovarian insufficiency (premature ovarian failure)", section on 'Estrogen therapy'.)
Estrogen is available in many forms: oral, transdermal, topical gels, emulsions and lotions, intravaginal creams and tablets, and vaginal rings. In some countries, estrogen can also be given as a subcutaneous implant (table 1) . Once a decision has been made to treat a woman with menopausal hormone therapy (MHT), consideration should be given to the type of estrogen and the route by which it is to be given, as well as the need for progestin and the most appropriate progestin regimen (see 'Progestin preparations' below). Estrogen doses used for women who have menopausal symptoms are typically lower than doses used to treat women with primary ovarian insufficiency (POI). (See "Management of spontaneous primary ovarian insufficiency (premature ovarian failure)", section on 'Estrogen therapy'.)
Women being treated for menopausal symptoms such as hot flashes require systemic estrogen; women being treated only for vulvovaginal atrophy (now referred to as “genitourinary syndrome of menopause” [GSM]) should be treated with low-dose vaginal estrogen rather than systemic estrogen. (See "Treatment of menopausal symptoms with hormone therapy" and "Treatment of genitourinary syndrome of menopause (vulvovaginal atrophy)".)
Systemic estrogens — Systemic estrogen is most often administered orally or transdermally (table 1) (see "Menopausal hot flashes"). There are several important differences in the effects of these preparations:
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- ESTROGEN PREPARATIONS
- Systemic estrogens
- - Oral estrogen
- - Transdermal estrogen
- - Topical estradiol
- Secondary exposure
- - Vaginal estrogens
- - Dose equivalents
- - Low-dose estrogen
- Conjugated estrogen-bazedoxifene
- Bioidentical hormone therapy
- PROGESTIN PREPARATIONS
- Medroxyprogesterone acetate
- Natural progesterone
- Levonorgestrel-releasing intrauterine device
- Quarterly progestin regimens
- Combination estrogen-progestin products
- - Oral
- - Transdermal
- BLEEDING PATTERNS
- Unopposed estrogen
- Cyclic combined regimens
- Continuous combined regimens
- - Breakthrough bleeding
- Endometrial monitoring
- OTHER HORMONE PREPARATIONS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS