Hormone Replacement Therapy (And Other Options to Treat Menopausal Symptoms)

The transition to menopause is associated with adverse cardiometabolic changes which increase the risk of cardiovascular disease. The decline in estrogen levels is associated with increase in fat mass, predominantly in the abdominal region, with insulin resistance and with dyslipidemia. Furthermore, the prevalence of hypertension increases after menopause. Menopausal symptoms, in particular vasomotor symptoms, are associated with a heightened risk of cardiovascular disease later in life. In this context, cardiovascular risk stratification has a central role in decision-making, concerning the replacement of sex hormones as well as the need for control of traditional cardiovascular risk factors. Women with premature ovarian insufficiency or early menopause should receive hormone replacement therapy until the average age of menopause. Women who transition into menopause after the age of 45 years, are eligible for hormone replacement therapy if they have bothersome menopausal symptoms, symptoms of urogenital atrophy or are at risk for an osteoporotic fracture. If initiated for these indications, hormone replacement therapy has also beneficial effects on cholesterol and glucose levels, insulin resistance and body composition. If hormone therapy is contraindicated or not desired, non-hormonal alternatives can be used to manage menopausal symptoms.