Hormone Therapy Safe in Menopause Management

Hormone Therapy Safe in Menopause ManagementShort-term hormone replacement therapy (HRT) is acceptable and relatively safe for healthy, symptomatic, recently postmenopausal women, according to a new consensus statement endorsed by 15 leading medical organizations involved in women's health.  

Hormone replacement therapy (HRT) is a treatment used to relieve symptoms of menopause. It replaces the female hormones, estrogen alone or estrogen and progesterone in combination that are no longer produced after menopause.

Signs of Menopause

Common changes you might notice are:

Types of Hormone Replacement Therapy? 


There are two main types of hormone replacement therapy:

  • Hormone Therapy Safe in Menopause ManagementEstrogen Therapy: Doctors prescribe a low dose of estrogen to be taken as a pill or patch every day. Estrogen may also be prescribed as a cream. You should take the lowest dose of estrogen needed to relieve menopause symptoms. Estrogen therapy as a single agent is sufficient in women who have undergone hysterectomy.  Local estrogen therapy is effective and preferred for women whose symptoms are limited to vaginal dryness or discomfort with intercourse; low-dose vaginal estrogen therapy is recommended in this setting.

  • Progesterone/Progestin-Estrogen Hormone Therapy: Also called combination therapy, this form of HRT combines doses of estrogen and progesterone (progestin is a synthetic form of progesterone). Estrogen and a lower dose of progesterone also may be given continuously to prevent the regular, monthly bleeding that can occur when combination HRT is used. The current recommendation is to take the lowest dose of hormone therapy for the shortest time possible. Like all prescription medications, HRT should be re-evaluated each year. Progestogen therapy is required to prevent endometrial cancer when estrogen is used systemically in women with a uterus.  

 Specific recommendations in the consensus statement includes 

(The new guidelines and rationale were issued jointly by the North American Menopause Society (NAMS), the American Society for Reproductive Medicine, and the Endocrine Society.)

  • The decision to use HRT must be individualized based on specific patient factors and anticipated risks and benefits. These include quality-of-life priorities, age, time since menopause, and risk for blood clots, heart disease, stroke, and breast cancer.

  • For healthy, relatively young women (younger than 59 years or within 10 years of menopause) with moderate to severe menopausal symptoms, systemic HRT is an acceptable option and is the most effective treatment.

  • Low-dose vaginal estrogen is the preferred treatment for women who have only vaginal dryness or discomfort with intercourse.

  • To prevent uterine cancer in women who still have a uterus, HRT should include progesterone or a similar progestogen, as well as estrogen. Women who have undergone hysterectomy can be given only estrogen.

  • Estrogen-only and estrogen-progestogen HRT are associated with increased risk for stroke and of venous thromboembolism (deep venous thrombosis and pulmonary embolus), as are hormone-based contraceptives. However, the risk is rare in women aged 50 to 59 years.

  • Use of continuous estrogen with progestogen therapy for at least 5 years, and possibly even for shorter duration, is associated with an increased risk for breast cancer. When HRT is discontinued, this risk decreases.

Duration of Therapy

Hormone Therapy Safe in Menopause ManagementThe lowest dose of hormone therapy should be used for the shortest amount of time to manage menopausal symptoms.

Although fewer than 5 years is recommended for estrogen with progestogen therapy, duration should be individualized.  For estrogen therapy alone, more flexibility in duration of therapy may be possible. There are reports of increased risk of breast cancer after 10 to 15 years of use in large observational studies with estrogen alone.

Although research is ongoing and these recommendations may be modified over time, there is no question that hormone therapy has an important role in managing symptoms for women during the menopausal transition and in early menopause.


For more details:



Dated 24 July 2012


Listen to the Podcast (what's this))

Related Links