Hormone Therapy for Menopause Management

Core Hormonal Therapy Options

The American College of Obstetricians and Gynecologists recommends combined estrogen-progestin therapy for women with an intact uterus to prevent endometrial hyperplasia and cancer, with a relative risk of 2.3 escalating to 9.5 after 10 years of use 1
Continuous combined therapy, such as daily estrogen plus daily progestin, minimizes breakthrough bleeding 2
Sequential/cyclic therapy, such as daily estrogen with progestin added for 10-14 days per month, may result in monthly withdrawal bleeding 2

Estrogen-alone therapy is appropriate for women without a uterus, as there is no endometrial cancer risk, and it shows a small reduction in invasive breast cancer risk compared to combined therapy 1
Estrogen-alone therapy carries risks including stroke, DVT, gallbladder disease, and urinary incontinence [4] [5]

Vaginal estrogen is used for low-dose local therapy for genitourinary symptoms and does not require progestin co-administration due to minimal systemic absorption [4] [6]
Hormone therapy is FDA-approved for short-term treatment of menopausal vasomotor symptoms, treatment of vulvovaginal atrophy/genitourinary syndrome of menopause, and prevention of osteoporosis [4] [5] 6

Combined estrogen-progestin therapy increases the risk of invasive breast cancer, stroke, venous thromboembolism, and gallbladder disease, with relative risks of 1.24-1.26, 33 vs 25 cases per 10,000 woman-years, and 2-4 fold increase, respectively [1] [4] 5
Combined estrogen-progestin therapy decreases the risk of hip fractures and colorectal cancer, with 11 vs 16 cases per 10,000 woman-years and 10 vs 16 cases per 10,000 woman-years, respectively [4] [5]
The US Preventive Services Task Force recommends against using hormone therapy for primary prevention of chronic conditions, with a Grade D recommendation [3] [4] 6