Table 1.
Data summarized from North American Menopause Society 2017 guidelines [1] and Endocrine Society Clinical Practice Guideline [42].
| Coronary Heart Disease (CHD) | Venous Thromboembolism (VTE) | Stroke | Mortality |
|---|---|---|---|
| - Menopausal hormone therapy (MHT) is a safe and effective treatment option of menopausal symptoms when introduced in healthy postmenopausal women that are within 10 years of menopause onset or aged younger than 60 years; some data suggest reduced risk of CHD in this age range. - It is important to evaluate the baseline risk of cardiovascular disease (CVD) and to consider this risk when advising for or against MHT and when selecting type, dose, and route of administration - For women at high risk of CVD, MHT is not recommended. -For women with moderate risk of CVD, transdermal estradiol should be offered as first-line treatment, alone for women without a uterus, or combined with micronized progesterone (or another progestogen that does not adversely modify metabolic parameters) for women with a uterus. - In women who start using MHT more than 10 years from menopause onset, and evidently by 20 years, there is potential for increased risk of CHD. -Hormone therapy is not FDA indicated for primary or secondary cardioprotection. |
- For women at increased risk of VTE who request MHT, a nonoral route of therapy at the lowest effective dose is recommended, if not contraindicated; -For women with a uterus, we recommend a progestogen (for ex. progesterone and dydrogestone) that is neutral on coagulation parameters. |
- A meta-analysis of randomized controlled trials (RCTs) of women who initiate MHT found no increased risk of stroke in women aged younger than 60 years or who were within 10 years of menopause onset, whereas observational study findings are mixed. - Lower-dose oral as well as lower-dose transdermal therapy has less effect on risk of stroke, compared with standard-dose oral MHT * |
Meta-analyses of RCTs report a significant reduction in all-cause mortality in women who initiate MHT when aged younger than 60 years and/or are within 10 years from menopause onset. - No protective effect was found in women with initiation more than 10 years from menopause onset. |
| Personal and familial risk of CVD, stroke, and VTE should be considered when initiating MHT. | |||
* Evidence based on observational studies and meta-analyses, although RCT data are still lacking.