Hormone Replacement Therapy for Menopausal Women: Benefits, Risks, and Recommendations

Hormone replacement therapy has been recommended as a first-line treatment for menopausal women without risk factors, offering significant benefits in improving quality of life.

FREMONT, CA: Menopause is a natural stage in a woman's life that can be accompanied by bothersome symptoms, significantly impacting their quality of life. While numerous treatment options exist, concerns over the risks associated with hormone replacement therapy (HRT) and a lack of awareness regarding available treatments often hinder patients from seeking appropriate care. However, recent research reviews have recommended HRT as a first-line treatment for menopausal women without risk factors, highlighting its potential to improve quality of life.

Experts agree that HRT can significantly enhance the quality of life for menopausal women. Practitioners must comprehensively evaluate patients' symptoms and engage in detailed discussions about the risks and expectations of therapy. When initiated early during the menopause or perimenopause years, HRT is considered reasonably low risk and can effectively alleviate symptoms.

Before commencing HRT, a thorough physical examination, medical history assessment, and symptom discussion are essential. Recommendations for hormone replacement therapy are tailored to each patient based on their unique symptoms, medical history, family history, and overall health status. This personalized approach ensures that the benefits of HRT are maximized while minimizing potential risks.

Previous studies raised concerns about an increased risk of breast cancer in women using HRT. 

However, recent evidence suggests the risk is lower for women in their 50s and those who initiate therapy within ten years of menopause onset. Additionally, some studies have indicated a higher risk of ischemic stroke in women over 60 who initiate HRT ten years after menopause onset. However, for women under 60, the risk is relatively low.

Older women using HRT may have a slightly increased coronary artery disease (CAD) risk. The risk and recommendations depend on the patient's age and existing medical conditions at HRT initiation. While the potential for increased CAD risk must be considered, experts emphasize that most women around 50 have a low risk of developing the disease. Digital risk estimators can help calculate the individual risk for patients with an elevated CAD risk, enabling informed discussions with the patient. Those with active CAD or a history of CAD are not suitable candidates for estrogen therapy.

Individuals with certain medical conditions should avoid HRT. People with breast, ovarian, or endometrial cancers, who have a strong family history of breast cancer, and who have blood clots, strokes, heart diseases, liver diseases, and untreated high blood pressure are at risk for these conditions. HRT should be used for the shortest duration and at the lowest effective dose, particularly for women under 60 or within ten years of menopause diagnosis, considering the individual's health profile.

While there are potential risks associated with HRT, the timing of therapy initiation appears to be a key factor. Healthcare practitioners should engage in thorough discussions with patients, weighing the benefits and risks to make informed decisions regarding hormone replacement therapy.