Hormone Therapy in Menopause: Concepts, Controversies, and Approach to Treatment

Abstract

Hormone therapy (HT) is an effective treatment for menopausal symptoms, including vasomotor symptoms and genitourinary syndrome of menopause. Randomized trials also demonstrate positive effects on bone health, and age-stratified analyses indicate more favorable effects on coronary heart disease and all-cause mortality in younger women (close proximity to menopause) than in women more than a decade past menopause. In the absence of contraindications or other major comorbidities, recently menopausal women with moderate or severe symptoms are appropriate candidates for HT. The WHI hormone therapy trials— estrogen and progestin (E+P) trial and the estrogen-alone (E-alone) trial— clarified the benefits and risks of HT, including how the results differed by age. A key lesson from the WHI trials, which was unfortunately lost in the post-trial cacophony, was that the risk:benefit ratio and safety profile of HT differed markedly by clinical characteristics of the participants, especially age, time since menopause, and comorbidity status. In the present review of the WHI and other recent HT trials, we aim to provide readers with an improved understanding of the importance of the timing of HT initiation, type and route of administration, and of patient-specific considerations that should be weighed when prescribing HT.

Follicle-Stimulating Hormone Glycosylation Variants Distinctly Modulate Pre-antral Follicle Growth and Survival

“…Clinically, this decline in ovarian reserve is associated with a truncated follicular phase and shortened menstrual cycle ( 5 ), and ultimately reduced fertility/infertility. The mid-life cessation of ovarian function increases susceptibility to several comorbidities, including diabetes, cardiovascular disease, osteoporosis, impaired cognitive function, and metabolic syndrome ( 6 , 7 ). Yet, little is known about the role of endocrinological mechanisms that contribute to the aging process.…”

Menopause, wellbeing and health: A care pathway from the European Menopause and Andropause Society

“…These can be summarized as follows [15,17,97,98,100,105,[123][124][125]: • Improved mood and wellbeing.…”

Treatment of Low Sexual Desire in Female Cancer Survivors

“…It is regrettable that the authors did not even mention the most effective treatment option, hormone replacement therapy (HRT), 2 which has been approved for loss of sexual desire by the US Food and Drug Administration and supported by a principal investigator of the Women's Health Initiative. 3 Given that approximately 80% of postmenopausal women suffer from menopausal symptoms, including loss of sexual desire and vaginal atrophy causing pain during intercourse, and that these symptoms last an average of 7.4 years, 4 this silence would seem unwarranted.…”