From the Guidelines
The typical starting point for menopause hormone replacement therapy (HRT) is low-dose estrogen, often combined with progestogen if you still have your uterus, with the goal of using the lowest effective dose for the shortest possible time.
Key Considerations
- Begin with the lowest effective dose, such as 0.3-0.45 mg of conjugated estrogens or 0.5-1 mg of estradiol daily, as recommended by various guidelines 1.
- For women with an intact uterus, add cyclic or continuous progestogen (e.g., 100-200 mg micronized progesterone daily) to protect against endometrial cancer.
- Start HRT at the onset of bothersome menopausal symptoms, typically around the time of the final menstrual period.
- Begin with a three-month trial to assess effectiveness and side effects, and if symptoms persist, gradually increase the dose.
- Transdermal estrogen (patches or gels) may be preferable for some women, especially those with a higher risk of blood clots.
Benefits and Risks
- HRT effectively manages vasomotor symptoms (hot flashes and night sweats) and vaginal dryness while offering protection against osteoporosis.
- However, HRT may increase the risk for venous thromboembolism, CHD, and stroke, particularly within the first 1 to 2 years of therapy, and the risk for breast cancer may increase with longer-term HRT 1.
Individualized Approach
- Always discuss individual risks and benefits with your healthcare provider before starting HRT, as personal medical history and risk factors will influence the appropriateness and specifics of treatment.
- The decision to initiate or continue HRT for menopausal symptoms should be made on the basis of discussions between a woman and her clinician, taking into account the latest evidence and guidelines 1.
From the Research
Starting Point for Hormone Replacement Therapy (HRT) in Menopause
The starting point for HRT in menopause is typically a low-dose regimen, as it has been shown to be effective in managing climacteric symptoms while minimizing adverse events 2, 3, 4, 5, 6.
Key Considerations
- Low-dose estrogen therapy, such as 25 mcg/day transdermally or 0.3 mg/day orally, has been found to be effective in controlling postmenopausal symptoms, reducing bone loss, and reducing cardiovascular risk factors 3, 4, 6.
- The introduction of low-dose HRT allows physicians to initiate or titrate patients to a low dose, reducing the risk of hyperestrogenic side effects 3, 5.
- Low-dose HRT has been shown to be effective in reducing vasomotor symptoms, even in highly symptomatic women, with a reduced incidence of breast tenderness and other side effects 2, 3, 6.
Benefits of Low-Dose HRT
- Effective control of climacteric symptoms
- Reduced risk of hyperestrogenic side effects
- Preservation of lumbar and femoral bone density
- Reduced risk of breast tenderness and other side effects
- Favorable effects on lipid and lipoprotein patterns