Prescribing menopausal hormone therapy: an evidence-based approach

Abstract

The constantly changing landscape regarding menopausal hormone therapy (MHT) has been challenging for providers caring for menopausal women. After a decade of fear and uncertainty regarding MHT, reanalysis of the Women’s Health Initiative data and the results of recent studies have provided some clarity regarding the balance of risks and benefits of systemic MHT. Age and years since menopause are now known to be important variables affecting the benefit-risk profile. For symptomatic menopausal women who are under 60 years of age or within 10 years of menopause, the benefits of MHT generally outweigh the risks. Systemic MHT initiated early in menopause appears to slow the progression of atherosclerotic disease, thereby reducing the risk of cardiovascular disease and mortality. During this window of opportunity, MHT might also provide protection against cognitive decline. In older women and women more than 10 years past menopause, the risk-benefit balance of MHT is less favorable, particularly with regard to cardiovascular risk and cognitive impairment. For women entering menopause prematurely (<40 years), MHT ameliorates the risk of cardiovascular disease, osteoporosis, and cognitive decline. Nonoral administration of estrogen offers advantages due to the lack of first-pass hepatic metabolism, which in turn avoids the increased hepatic synthesis of clotting proteins, C-reactive protein, triglycerides, and sex hormone-binding globulin. The duration of combined MHT use is ideally limited to less than 5 years because of the known increase in breast cancer risk after 3–5 years of use. Limitations to use of estrogen only MHT are less clear, since breast cancer risk does not appear to increase with use of estrogen alone. For women under the age of 60 years, or within 10 years of onset of natural menopause, MHT for the treatment of bothersome menopausal symptoms poses low risk and is an acceptable option, particularly when nonhormonal management approaches fail.

Management of Chronic Medication Therapies in the Perioperative Period: a Literature Review

“…Postmenopausal hormone replacement therapies that contain oestrogen increase the risk of thromboembolic events [17]. It may therefore be reasonable to discontinue these medications before surgeries.…”

Optimized HPLC -UV Method for Separation, Detection and Quantification of Endocrine Disrupting Estrogens in Low Quality Water

“…There are natural and synthetic estrogens; the natural estrogens are not only produced by humans but also by other vertebrates as well as invertebrates particularly insects (Das, 2016). The synthetic estrogens are used for birth control, hormone replacement therapies, cancer drugs and other pharmaceuticals (Shook, 2011;Sood et al, 2014). Usually the estrogens are excreted from humans and animals mainly as conjugates of glucuronide or sulphate and a lesser amount as parent compounds in urine and faeces.…”

The effectiveness and safety of mht depending on the type, route of administration of estrogens, and the type of progestogen. Analysis of data from clinical trials and international recommendations

“…В дополнение к связыванию с рецепторами прогестерона эти соединения могут также иметь сродство к андроген-ным, глюкокортикоидным и минералокортикоидным ре-цепторам [13]. Хотя некоторые данные свидетельствуют о том, что MГT увеличивает риск РМЖ [14], этот риск может различаться в зависимости от типа используемого проге-стина. Так, MГT с применением препарата, содержащего конъюгированные лошадиные эстрогены (CEE) и MПA, ас-социировалась с повышенным риском РМЖ по сравнению с только CEE [3].…”