Optimizing menopausal hormone therapy use: A review

Abstract

Menopausal hormone therapy (MHT) has been used in clinical practice for postmenopausal women for decades. With further analysis and newer studies, the benefits, and risks of MHT have been repeatedly verified and discussed. MHT is essential to combat the vasomotor and genitourinary symptoms of menopause as well as to reduce the risk of fractures and manage osteoporosis in postmenopausal women. Before prescribing appropriate hormonal therapy to menopausal women it is important to navigate through the process of weighing risks against benefits effectively Identifying the window of opportunity to commence treatment, selecting the right estrogen and progestogen formulation, and administering the appropriate dose for optimal duration while maintaining the lowest risk profile has been a challenge for clinicians especially for two decades since the risks of hormone replacement therapy were strongly highlighted. To counter the risks and to optimize hormonal regulation, detailed recommendations are given including proposed dosages for the various available estrogens and estrogen/progestogens combinations. Determining how to make the best use of MHT to improve quality of life of postmenopausal women by optimizing the initiation time, regimen, and duration is crucial. This review discusses the guidelines and strategies for prescribing MHT in India for the management of estrogen deficiency symptoms, with focus on genitourinary and vasomotor symptoms, considering the long-term impact on prevention of osteoporosis and cardiovascular disease.