Hormone Replacement Therapy in Females

Estradiol Administration

The recommended adult dose of transdermal estradiol is 50-100 μg/day via patches that are changed twice weekly or weekly depending on the specific product, as recommended by the American College of Obstetricians and Gynecologists 1, 2
Transdermal estradiol administration shows better profiles for bone mass accrual and cardiovascular risk compared to oral formulations, according to the North American Menopause Society 2
The recommended adult dose of oral estradiol is 1-2 mg daily of 17β-estradiol, as suggested by the Endocrine Society 2, 3

For women with an intact uterus, progestin must be added to estrogen therapy to reduce endometrial cancer risk, as recommended by the American College of Obstetricians and Gynecologists 2, 3
Micronized progesterone is preferred due to lower cardiovascular and venous thromboembolism risk, according to the North American Menopause Society 2, 3

Testosterone therapy for females with diminished libido is supported by limited data, and treatment effect should be evaluated after 3-6 months, as suggested by the International Society for the Study of Women's Sexual Health 4, 5
Therapy should be limited to 24 months due to unclear long-term health effects, as recommended by the Endocrine Society 4, 5

HRT should be continued until the average age of spontaneous menopause (45-55 years), and after menopause age, continuation decisions should be based on individual risks, family history, and symptom severity, as recommended by the American College of Obstetricians and Gynecologists 2, 3
Lower post-menopausal doses have more favorable risk-benefit profiles, according to the North American Menopause Society 2, 3

HRT is generally contraindicated in breast cancer survivors, as recommended by the American Cancer Society 4, 5
Migraine should not be considered a contraindication to HRT use, according to the American Headache Society 4, 5
Women who underwent total body irradiation or survived Hodgkin lymphoma have increased breast cancer risk and require strict follow-up, as recommended by the American Cancer Society 2, 3