Hormone Replacement Therapy for Menopausal Women with Type 2 Diabetes

Initial Assessment and Risk Stratification

Vasomotor symptoms are defined as recurrent, transient episodes of flushing, perspiration, and sensations ranging from warmth to intense heat on the upper body and face, sometimes followed by chills, in women with type 2 diabetes mellitus experiencing menopausal symptoms 1
The benefit-risk profile for HRT is most favorable for women ≤60 years old or within 10 years of menopause onset, making a 50-year-old patient an appropriate candidate for hormone replacement therapy, according to the American College of Obstetricians and Gynecologists 2

HRT is contraindicated in women with a history of breast cancer or other hormone-sensitive cancers, as recommended by the American College of Obstetricians and Gynecologists 3
HRT is contraindicated in women with active liver disease, as stated by the Arthritis and Rheumatology society 1, 3
HRT is contraindicated in women with a history of venous thromboembolism or stroke, according to the Arthritis and Rheumatology society 1, 3
HRT is contraindicated in women with antiphospholipid syndrome, as recommended by the Arthritis and Rheumatology society 1
HRT is contraindicated in women with undiagnosed abnormal vaginal bleeding, according to the American College of Obstetricians and Gynecologists 3

Initiating HRT solely for prevention of chronic conditions rather than for symptom management is not recommended, as stated by the American College of Obstetricians and Gynecologists 2, 3
Using estrogen therapy without progestin in women with an intact uterus increases endometrial cancer risk, according to the American College of Obstetricians and Gynecologists 3
Using paroxetine or fluoxetine as alternatives in women taking tamoxifen is not recommended, if applicable, as stated by the Journal of Clinical Oncology 4