Hormone therapy after onset of menopause is a complex issue. A couple decades ago it was widely accepted as a way to suppress symptoms and side effects of menopause. Subsequently, we had fears that it may be linked with breast cancer or cardiovascular disease, with potential to shorten life span.
An international group of professional societies has published some guidelines recently:
The consensus recommendations included the following, as listed at MedPageToday:
- Among women younger than 60 or within 10 years after menopause, estrogen-alone HRT at standard doses “may decrease coronary heart disease and all-cause mortality.” Mortality benefits of estrogen plus progestogen in this group are less clear with no increase or decrease in cardiovascular risk.
- For women whose only menopause symptom is vaginal dryness or discomfort during intercourse, low-dose topical estrogen is preferred.
- Estrogen-only HRT is preferred in women after hysterectomy; other women should receive estrogen plus progestogen.
- Venous thromboembolism and ischemic stroke risk increases with oral HRT but the absolute risk remains low in women younger than 60. Such risks may be smaller with transdermal therapy.
- HRT is not recommended in breast cancer survivors.
- Custom-compounded “bioidentical” hormone therapy is not recommended.