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The Women's Health Initiative clarified that menopausal hormone therapy has both benefits and risks that depend on age, timing, formulation and patient characteristics. Estrogen plus progestin effectively reduces vasomotor symptoms and protects against fractures, but long-term randomized trial data showed increased risks of breast cancer and thromboembolic events in the studied population. Subsequent analyses have reinforced the importance of starting treatment near menopause when appropriate and using the lowest effective dose for the shortest duration consistent with treatment goals, while recognizing that individual risk varies. For gynecologists, the practical task is shared decision-making. Women with severe symptoms may derive substantial quality-of-life benefit, but cardiovascular, thrombotic, breast-cancer and uterine risks must be assessed. Nonhormonal treatments and local vaginal estrogen may be appropriate alternatives for specific symptom profiles.
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The Women's Health Initiative clarified that menopausal hormone therapy has both benefits and risks that depend on age, timing, formulation and patient characteristics. Estrogen plus progestin effectively reduces vasomotor symptoms and protects against fractures, but long-term randomized trial data showed increased risks of breast cancer and thromboembolic events in the studied population. Subsequent analyses have reinforced the importance of starting treatment near menopause when appropriate and using the lowest effective dose for the shortest duration consistent with treatment goals, while recognizing that individual risk varies. For gynecologists, the practical task is shared decision-making. Women with severe symptoms may derive substantial quality-of-life benefit, but cardiovascular, thrombotic, breast-cancer and uterine risks must be assessed. Nonhormonal treatments and local vaginal estrogen may be appropriate alternatives for specific symptom profiles.
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