Prescribing Menopausal Hormone Therapy

Women experience a unique set of symptoms related to estrogen deficiency both in perimenopause and menopause. Vasomotor symptoms (VMS) including hot flushes, night sweats and sleep disturbances, genitourinary symptoms, mood swings, and depression can adversely affect the quality of life. Many chronic diseases such as hypertension, diabetes mellitus, coronary artery disease, and osteoporosis are also associated with menopause. Menopausal hormone therapy (MHT) is a highly effective treatment for VMS and GSM (genitourinary syndrome of menopause) and protects against bone loss and fracture. Our knowledge of the effects of MHT has evolved over the last few decades leading to a better understanding of its advantages, risks, and side effects. The benefits and risks may vary based on the type, route, timing of initiation, dose, duration, and use of progestogen. Taking stock of the available evidence treatment should be individualized after careful consideration of age, menopause stage, symptoms, risk factors, and individual preferences, thus aiming to minimize the risks and maximize the benefits of MHT. Initiating MHT in women <60 years or within 10 years of menopause gives greater benefits and fewer risks.