Rethinking Menopausal Hormone Therapy: For Whom, What, When, and How Long?

Circulation. 2023 Feb 14;147(7):597-610. doi: 10.1161/CIRCULATIONAHA.122.061559. Epub 2023 Feb 13.

Abstract

Menopausal hormone therapy (HT) was widely used in the past, but with the publication of seminal primary and secondary prevention trials that reported an excess cardiovascular risk with combined estrogen-progestin, HT use declined significantly. However, over the past 20 years, much has been learned about the relationship between the timing of HT use with respect to age and time since menopause, HT route of administration, and cardiovascular disease risk. Four leading medical societies recommend HT for the treatment of menopausal women with bothersome menopausal symptoms. In this context, this review, led by the American College of Cardiology Cardiolovascular Disease in Women Committee, along with leading gynecologists, women's health internists, and endocrinologists, aims to provide guidance on HT use, including the selection of patients and HT formulation with a focus on caring for symptomatic women with cardiovascular disease risk.

Keywords: cardiovascular diseases; coronary artery disease; hormone replacement therapy; hyperlipidemias; hypertension; menopause; venous thromboembolism.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cardiovascular Diseases* / chemically induced
  • Cardiovascular Diseases* / epidemiology
  • Cardiovascular Diseases* / prevention & control
  • Estrogen Replacement Therapy* / adverse effects
  • Estrogen Replacement Therapy* / methods
  • Estrogens / adverse effects
  • Female
  • Hormone Replacement Therapy / adverse effects
  • Humans
  • Menopause

Substances

  • Estrogens