Hormone Therapy for Postmenopausal Women

As women age and estrogen levels decline, risks increase for osteoporosis, cardiovascular disease, and cognitive decline. Although 70 to 80% of menopausal women notice hot flashes and night sweats (vasomotor symptoms), transient sensations of heat, sweating, flushing, anxiety, or chills lasting for 1 to 5 minutes (or some combination thereof), only 25% seek help. With declining estrogen levels, the thermoregulatory zone narrows, leading to hot flashes in symptomatic women. Risks for hot flashes include early or surgical menopause; black race or Hispanic ethnic group; a high body-mass index or sedentary lifestyle; smoking; stress, anxiety, and depression; posttraumatic stress disorder, partner violence, and sexual assault; and use of selective estrogen-receptor modulators or aromatase inhibitors.

Hormone Therapy for Postmenopausal Women

1.Women younger than 60 years of age or within 10 years after the onset of menopause who have symptomatic menopausal hot flashes or night sweats are most likely to benefit from hormone therapy.

2.For women with early menopause without contraindications, hormone therapy is recommended until at least the average age of natural menopause.

3.Observational studies suggest that the risk of thromboembolism and stroke is lower with transdermal therapy than with oral hormone therapy.

4.Compounded bioidentical hormone therapies that have not been approved by the Food and Drug Administration are not recommended owing to safety concerns.

5.Hormone therapy is not recommended for primary or secondary prevention of coronary heart disease or dementia.

6.Nonhormone therapies that have been shown to reduce hot flashes include low-dose selective serotonin-reuptake inhibitors and serotonin–norepinephrine reuptake inhibitors, gabapentinoids, weight loss, hypnosis, and cognitive behavioral therapy.

7.For women with only genitourinary symptoms, local vaginal hormone therapies are recommended.

Source: https://www.nejm.org/doi/full/10.1056/NEJMcp1714787 (full).

 

Theo The New England Journal of Medicine