Hormone therapy for menopausal symptoms: Putting benefits and risks into perspective
Too many patients have needlessly foregone the relief provided by hormone therapy; timing of treatment can make all the difference.
Initiating HT for symptom control in newly menopausal women may provide additional benefits, such as reduced osteoporosis and cardiovascular risk, that outweigh the small risks associated with HT in this younger age group.
Evaluate the relative risks vs benefits, and use the lowest effective dose. Evaluate older women in a similar fashion. Those who continue to experience symptoms after discontinuing HT can be restarted on low-dose HT if symptoms do not abate.
TABLE
Select hormone therapy according to nature and severity of symptoms5,10,23
| Symptoms | Severity | Treatment |
|---|---|---|
| 2 hot flashes per day | Mild | Exercise Diet Environmental temperature regulation |
| 5-7 hot flashes per day Nighttime awakenings Night sweats/insomnia | Moderate-to-severe | HT for appropriate patients |
| Vaginal symptoms only (atrophic vaginitis) | Moderate-to-severe | Vaginal estrogen therapy |
| Osteoporosis | Established reduction in bone mass | Calcium + vitamin D plus bisphosphonate or raloxifene or extended HT for appropriate patients when preceding therapies are not tolerated or not appropriate |
Optimal candidates for HT:
| ||
| HT, hormone therapy. | ||
CORRESPONDENCE Michelle P. Warren, MD, Presbyterian Hospital, 622 West 168th Street, New York, NY 10032; mpw1@columbia.edu
