There are many options available to address the quality of life and health concerns of menopausal women. The principal indication for hormone therapy (HT) is the treatment of vasomotor symptoms, and benefits generally outweigh risks for healthy women with bothersome symptoms who elect HT at the time of menopause. Although HT increases the risk of coronary heart disease, recent analyses confirm that this increased risk occurs principally in older women and those a number of years beyond menopause. These findings do not support a role for HT in the prevention of heart disease but provide reassurance regarding the safety of use for hot flushes and night sweats in otherwise healthy women at the menopausal transition. An increased risk of breast cancer with extended use is another reason short-term treatment is advised. Hormone therapy prevents and treats osteoporosis but is rarely used solely for this indication. If only vaginal symptoms are present, low-dose local estrogen therapy is preferred. Contraindications to HT use include breast or endometrial cancer, cardiovascular disease, thromboembolic disorders, and active liver disease. Alternatives to HT should be advised for women with or at increased risk for these disorders. The lowest effective estrogen dose should be provided for the shortest duration necessary because risks increase with increasing age, time since menopause, and duration of use. Women must be informed of the potential benefits and risks of all therapeutic options, and care should be individualized, based on a woman's medical history, needs, and preferences.
The principal indication for hormone therapy is treatment of vasomotor symptoms, and benefits generally outweigh risks for symptomatic healthy women at the time of menopause.
From the Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, and Vincent Obstetrics and Gynecology Service, Massachusetts General Hospital, Boston, Massachusetts.
Continuing medical education is available for this article at http://links.lww.com/AOG/A166.
Corresponding author: Jan L. Shifren, MD, Massachusetts General Hospital, Vincent Obstetrics and Gynecology Service, 55 Fruit Street, YAW 10A, Boston, MA 02114; e-mail: firstname.lastname@example.org.
Financial Disclosure Dr. Shifren serves as a scientific advisory board member for the New England Research Institutes. She has been a research study consultant for Eli Lily & Co. (Indianapolis, Indiana) and Boehringer Ingelheim (Ingelheim, Germany). She also has received research support from Proctor & Gamble Pharmaceuticals (Cincinnati, Ohio). The other author did not report any potential conflicts of interest.