From the Guidelines
Hormone therapy for women should be individualized, with the goal of using the lowest effective dose for the shortest time needed, typically 5 years or less for systemic therapy, as recommended by recent guidelines 1.
Key Considerations
- The most common form of hormone therapy is menopausal hormone therapy (MHT), which typically consists of estrogen alone for women without a uterus, or estrogen plus progestin for those with a uterus to protect against endometrial cancer.
- Standard estrogen options include oral estradiol (0.5-1mg daily), transdermal patches (0.025-0.1mg/day), or vaginal preparations like creams or rings for localized symptoms.
- Progestin options include oral medroxyprogesterone acetate (2.5mg daily) or micronized progesterone (100-200mg daily).
- For perimenopausal women with irregular cycles, low-dose birth control pills containing ethinyl estradiol with progestins can help regulate periods and provide symptom relief.
- Bioidentical hormone therapy, which uses hormones chemically identical to those the body produces, is available in FDA-approved forms or as custom-compounded preparations.
Benefits and Risks
- Hormone therapy helps with hot flashes, night sweats, vaginal dryness, bone loss, and mood changes by replacing hormones that decline during menopause.
- However, hormone therapy is associated with an increased risk of certain health problems, such as blood clots, stroke, and breast cancer, as noted in studies 1.
- The timing of hormone therapy initiation and duration of use can impact the balance of benefits and risks, with earlier initiation and shorter duration generally considered safer 1.
Special Considerations
- Women with a history of hormone-sensitive cancers, such as breast cancer, may need to avoid hormone therapy or use alternative treatments, as recommended by guidelines 1.
- Regular follow-up with healthcare providers is essential to monitor benefits and risks and adjust treatment as needed.
Recent Guidelines
- The most recent guidelines recommend individualized treatment, with consideration of the woman's clinical situation, preferences, and values to maximize benefits over harms 1.
- The guidelines also emphasize the importance of using the lowest effective dose for the shortest time needed, typically 5 years or less for systemic therapy.
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. Medroxyprogesterone acetate tablets, USP are indicated for the treatment of secondary amenorrhea and abnormal uterine bleeding due to hormonal imbalance in the absence of organic pathology, such as fibroids or uterine cancer. They are also indicated for use in the prevention of endometrial hyperplasia in nonhysterectomized postmenopausal women who are receiving daily oral conjugated estrogens 0.625 mg tablets.
Hormone therapy options for women include:
- Estrogen-alone therapy for women without a uterus
- Combination therapy with estrogen and progestin for women with a uterus to reduce the risk of endometrial cancer
- Medroxyprogesterone acetate for the treatment of secondary amenorrhea and abnormal uterine bleeding due to hormonal imbalance, and for the prevention of endometrial hyperplasia in nonhysterectomized postmenopausal women receiving conjugated estrogens 2 3
From the Research
Hormone Therapy Options for Women
Hormone therapy is an effective treatment for menopausal symptoms, including vasomotor symptoms and genitourinary syndrome of menopause 4, 5, 6. The benefits of hormone therapy include:
- Relief of vasomotor symptoms, such as hot flashes and night sweats 6
- Improvement of genitourinary syndrome of menopause 4
- Protection from chronic diseases, such as osteoporosis and coronary heart disease 5, 7
- Improvement of sleep quality and mood disorders 8
Eligibility for Hormone Therapy
Women who are eligible for hormone therapy include:
- Recently menopausal women with moderate or severe symptoms 4
- Women under the age of 60 or within 10 years of menopause onset 5, 7
- Women with a high risk of fracture or osteoporosis 5
Types and Routes of Administration
There are various types and routes of administration of hormone therapy, including:
- Estrogen therapy, available in different preparations, routes of administration, and dosing 8
- Combined estrogen and progestin therapy 4
- Different routes of administration, such as oral, transdermal, or vaginal 6
Patient-Specific Considerations
When prescribing hormone therapy, patient-specific considerations should be taken into account, including: