Highlights & Basics
- The diagnosis of menopause is clinical, based on the absence of menses for 12 months, and does not require further testing for appropriately presenting patients.
- Estrogen therapy is an effective treatment for the management of menopausal symptoms including hot flashes, night sweats, and urogenital symptoms.
- For women with an intact uterus, a progestin must be co-administered with an estrogen to protect against endometrial hyperplasia and cancer.
- Arbitrary limits should not be placed on the duration of use of hormone therapy (HT); all patients require individualized decision-making. Reassessment should occur at least annually. Transdermal administration of estradiol is associated with a lower risk of stroke and venous thromboembolism than oral administration of estradiol and is unlikely to increase the risk of stroke and venous thrombosis above that of non-users.
- Nonhormonal interventions may help women who have a contraindication to, or cannot tolerate, HT. However, they are less effective than HT in controlling menopausal symptoms.
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Absolute rates of coronary heart disease for different types of hormone therapy (HT) compared with no HT (or placebo), different durations of HT use, and time since stopping HT for menopausal women.
Absolute rates of stroke for different types of hormone therapy (HT) compared with no HT (or placebo), different durations of HT use, and time since stopping HT for menopausal women.
Summary of HRT risks and benefits* during current use and current use plus post-treatment from age of menopause up to age 69 years, per 1000 women with 5 years or 10 years use of HRT. Key: *Menopausal symptom relief is not included in this table, but is a key benefit of HRT and will play a major part in the decision to prescribe HRT. †Best estimates based on relative risks of HRT use from age 50. For breast cancer this includes cases diagnosed during current HRT use and diagnosed after HRT use until age 69 years; for other risks, this assumes no residual effects after stopping HRT use. § Latest evidence suggests that transdermal HRT products have a lower risk of VTE than oral preparations
Citations
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The North American Menopause Society Advisory Panel. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022 Jul 1;29(7):767-94.[Abstract]
Marjoribanks J, Farquhar C, Roberts H, et al. Long-term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev. 2017 Jan 17;(1):CD004143.[Abstract][Full Text]
Manson JE, Aragaki AK, Rossouw JE, et al. Menopausal hormone therapy and long-term all-cause and cause-specific mortality: the women's health initiative randomized trials. JAMA. 2017 Sep 12;318(10):927-38.[Abstract]
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