Postmenopausal Hormone Therapy—Local and Systemic: A Pharmacologic Perspective

Abstract

Every woman, if she lives long enough, will transition into menopause, and as the US population ages, women will be spending more time in a postmenopausal state than before. For postmenopausal women, the decision to initiate menopausal hormone therapy should be individualized. A thorough evaluation of the patient's cardiovascular, venous thromboembolic, cancer, and fracture risk should be considered along with the woman's quality of life. Hormone therapy exerts its therapeutic effects on vasomotor symptoms, the skeleton, and the genitourinary system independent of age since menopause and these benefits are lost once hormone therapy is stopped. Here we review the pharmacologic properties dose, formulation, mode of administration, timing of initiation, and duration of hormonal therapies in regard to optimizing benefit and minimizing risk to the patient. This discussion will focus on the effects of common hormonal therapies including estrogen (local and systemic), progesterone, estrogen receptor agonist/antagonist, and local dehydroepiandrosterone and include a brief review of compounded bioidentical hormone therapy.

A Clinical Review on Paroxetine and Emerging Therapies for the Treatment of Vasomotor Symptoms

“… 9 , 10 Menopausal hormone therapy is an effective treatment for VMS and is considered to be a safe treatment option in healthy menopausal women when initiated before the age of 60 or within 10 years of menopause. 11 , 12 In addition to managing bothersome menopausal symptoms, hormone therapy (HT) effectively reduces the risk of fractures associated with menopausal bone loss and osteoporosis. 11 , 12 Multiple studies have demonstrated beneficial cardiovascular effects of timely HT use, especially in women who undergo menopause before the age of 45.…”

“… 11 , 12 In addition to managing bothersome menopausal symptoms, hormone therapy (HT) effectively reduces the risk of fractures associated with menopausal bone loss and osteoporosis. 11 , 12 Multiple studies have demonstrated beneficial cardiovascular effects of timely HT use, especially in women who undergo menopause before the age of 45. 13 …”

Contemporary Non-hormonal Therapies for the Management of Vasomotor Symptoms Associated with Menopause: A Literature Review

“…3,4 Menopausal hormone therapy is considered a standard treatment for bothersome vasomotor symptoms. 5 For the average healthy postmenopausal woman, hormone therapy is considered a safe and effective treatment of bothersome vasomotor symptoms when initiated within 10 years of menopause or under the age of 60 years. 4,5 In addition to quality of life benefits, menopausal hormone therapy is a recognized treatment for reducing the risk of fractures associated with osteoporosis.…”

“…5 For the average healthy postmenopausal woman, hormone therapy is considered a safe and effective treatment of bothersome vasomotor symptoms when initiated within 10 years of menopause or under the age of 60 years. 4,5 In addition to quality of life benefits, menopausal hormone therapy is a recognized treatment for reducing the risk of fractures associated with osteoporosis. Recent publications have also addressed the cardiovascular benefits of menopausal hormone therapy, especially in women who undergo early menopause.…”

“…6 Despite the well documented benefits of menopausal hormone therapy, utilization of US Food and Drug Administration (FDA)-approved therapies has declined in eligible women due to perceived safety concerns. 5 Given the burden that vasomotor symptoms may have on an individual woman, non-hormonal treatments should be considered for the management of bothersome vasomotor symptoms when hormonal options are contraindicated or not preferred by the patient. In addition, women with a history of estrogen-dependent cancers or those who may be at elevated risk for such, those with coronary artery disease, or those with a history of stroke or venous thromboembolism should consider these alternative options.…”