Hormone Therapy for Postmenopausal Women

This clinical review examines the benefits and risks of hormone therapy for postmenopausal women, focusing on symptom relief and long-term health outcomes. Hormone therapy is most effective for managing vasomotor symptoms (e.g., hot flashes, night sweats) and genitourinary syndrome of menopause, particularly in women under 60 or within 10 years of menopause onset. The article discusses findings from the Women’s Health Initiative (WHI) trial, which initially raised concerns about cardiovascular risks and breast cancer but later analyses suggested a nuanced risk-benefit profile based on timing and patient age. Transdermal estrogen may reduce thromboembolism risk compared to oral therapy. Nonhormonal alternatives, such as SSRIs, SNRIs, and gabapentinoids, are recommended for women with contraindications to hormone therapy. Guidelines from professional societies emphasize individualized treatment, avoiding compounded bioidentical hormones, and limiting therapy duration for certain populations. The review concludes with recommendations for clinical practice, including low-dose transdermal estrogen for symptomatic women and nonhormonal options for those at high risk for breast cancer or cardiovascular disease.

This clinical review examines the benefits and risks of hormone therapy for postmenopausal women, focusing on symptom relief and long-term health outcomes. Hormone therapy is most effective for managing vasomotor symptoms (e.g., hot flashes, night sweats) and genitourinary syndrome of menopause, particularly in women under 60 or within 10 years of menopause onset. The article discusses findings from the Women’s Health Initiative (WHI) trial, which initially raised concerns about cardiovascular risks and breast cancer but later analyses suggested a nuanced risk-benefit profile based on timing and patient age. Transdermal estrogen may reduce thromboembolism risk compared to oral therapy. Nonhormonal alternatives, such as SSRIs, SNRIs, and gabapentinoids, are recommended for women with contraindications to hormone therapy. Guidelines from professional societies emphasize individualized treatment, avoiding compounded bioidentical hormones, and limiting therapy duration for certain populations. The review concludes with recommendations for clinical practice, including low-dose transdermal estrogen for symptomatic women and nonhormonal options for those at high risk for breast cancer or cardiovascular disease.