Management of menopausal hormone therapy.

PURPOSE OF REVIEW: The purpose of this review is to provide practical guidance on managing menopausal hormone therapy (MHT) and to provide updated guidance on the risks and benefits of MHT.

RECENT FINDINGS: Reanalysis of the Women's Health Initiative and recent studies have demonstrated the protective role of estrogen in cardiovascular disease (CVD) and bone health, particularly when initiated before the age of 60. There is an increased risk of venous thromboembolism (VTE) with oral formulations, but formulations using transdermal estradiol and micronized progesterone do not appear to increase VTE risk. MHT may be helpful in perimenopausal and menopausal mood disorders. The timing hypothesis may be applicable to both CVD and cognition.

SUMMARY: Management of symptomatic menopause requires personalized risk assessment and shared decision-making with a knowledgeable provider. For otherwise healthy women less than 60 years old or within 10 years of menopause, hormone therapy is a safe and effective treatment for vasomotor symptoms. Although the role of MHT is being studied for various preventive strategies, major medical societies do not yet recommend MHT for primary prevention.