From the FDA Drug Label
When estrogen therapy is prescribed for a postmenopausal woman with a uterus, progestin should also be initiated to reduce the risk of endometrial cancer. Use of estrogen-alone, or in combination with a progestin, should be with the lowest effective dose and for the shortest duration consistent with treatment goals and risks for the individual woman. PREMARIN therapy is indicated in the: Treatment of moderate to severe vasomotor symptoms due to menopause. Treatment of moderate to severe symptoms of vulvar and vaginal atrophy due to menopause.
The recommended treatment for low estrogen levels during menopause is estrogen therapy with the lowest effective dose and for the shortest duration consistent with treatment goals and risks for the individual woman 1.
- Estrogen-alone or in combination with a progestin may be prescribed.
- Progestin should also be initiated to reduce the risk of endometrial cancer in postmenopausal women with a uterus.
- The treatment goals include relieving moderate to severe vasomotor symptoms and symptoms of vulvar and vaginal atrophy due to menopause 1.
From the Research
Hormone replacement therapy (HRT) is the primary recommended treatment for low estrogen levels during menopause, with the most recent guidelines suggesting the use of transdermal estrogen preparations and micronized progesterone to minimize risks 2. The most common form of HRT is estrogen therapy, which can be prescribed as oral tablets, transdermal patches, or topical gels/creams. For women with an intact uterus, progesterone must be added to prevent endometrial cancer. Some key points to consider when prescribing HRT include:
- Using the lowest effective dose for the shortest time needed
- Considering the use of transdermal estrogen preparations to minimize the risk of thrombotic events and cardiovascular disease
- Using micronized progesterone as a safer alternative when progesterone is necessary
- Individualizing treatment duration and considering non-hormonal alternatives for symptomatic relief, such as SSRIs/SNRIs, gabapentin, or clonidine for hot flashes, and regular moisturizers for vaginal symptoms. According to the American Association of Clinical Endocrinologists and American College of Endocrinology position statement, HRT should be based on consideration of all risk factors for cardiovascular disease, age, and time from menopause 2. Additionally, lifestyle modifications such as regular exercise, maintaining a healthy weight, and avoiding triggers like alcohol and spicy foods can complement medical treatment. It's also important to note that the use of bioidentical hormone therapy is not recommended, and HRT is not recommended for the prevention of diabetes 2. Overall, the goal of HRT is to alleviate menopausal symptoms, improve quality of life, and minimize the risk of long-term health consequences, such as osteoporosis and cardiovascular disease, as supported by studies 3, 4, 5, 6.