Hormone therapy for menopausal symptoms: Putting benefits and risks into perspective

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Applied Evidence

Hormone therapy for menopausal symptoms: Putting benefits and risks into perspective

J Fam Pract. 2010 December;59(12):E1-E7

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References

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Initiating HT for symptom control in newly menopausal women may provide additional benefits, such as reduced osteoporosis and cardiovascular risk, that outweigh the small risks associated with HT in this younger age group.

Evaluate the relative risks vs benefits, and use the lowest effective dose. Evaluate older women in a similar fashion. Those who continue to experience symptoms after discontinuing HT can be restarted on low-dose HT if symptoms do not abate.

TABLE
Select hormone therapy according to nature and severity of symptoms^5,10,23

Symptoms	Severity	Treatment
2 hot flashes per day	Mild	Exercise Diet Environmental temperature regulation
5-7 hot flashes per day Nighttime awakenings Night sweats/insomnia	Moderate-to-severe	HT for appropriate patients
Vaginal symptoms only (atrophic vaginitis)	Moderate-to-severe	Vaginal estrogen therapy
Osteoporosis	Established reduction in bone mass	Calcium + vitamin D plus bisphosphonate or raloxifene or extended HT for appropriate patients when preceding therapies are not tolerated or not appropriate
Optimal candidates for HT: recently menopausal (<10 years) <60 years of age no risk factors for cardiovascular disease or breast cancer.
HT, hormone therapy.

CORRESPONDENCE Michelle P. Warren, MD, Presbyterian Hospital, 622 West 168th Street, New York, NY 10032; mpw1@columbia.edu