Hormone Replacement Therapy Guidelines

Patient Selection and Monitoring

Women with an intact uterus must receive concurrent progestin therapy to prevent endometrial hyperplasia, with options including micronized progesterone 200 mg orally or vaginally for 12-14 days every 28 days in sequential regimens, according to the Blood Reviews guideline society 1
Confirm negative pregnancy status before initiating therapy, as estradiol is pregnancy category X, and measure blood pressure at baseline and every visit, as hypertension is a common adverse effect that increases stroke risk, as recommended by the Praxis Medical Insights guideline society 2
Screen for absolute contraindications including active or history of thromboembolic disease, uncontrolled hypertension, hepatic disease, breast cancer, and migraine with focal neurologic symptoms, as advised by the Praxis Medical Insights guideline society 2
Do not prescribe to women ≥35 years who smoke, as this substantially increases stroke risk, according to the Praxis Medical Insights guideline society 2

Continue hormone replacement therapy until the average age of spontaneous menopause (45-55 years) in women with premature ovarian insufficiency, as recommended by the Blood Reviews guideline society 1