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Pharmacotherapies for Menopause Management: Hormonal Options

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Essentials of Menopause Management

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Abstract

Prior to the release of the initial findings of the Women’s Health Initiative (WHI) in 2002, menopausal hormone therapy (MHT) was not only used to relieve hot flashes and night sweats but had widespread acceptance for the prevention of heart disease, osteoporosis, and Alzheimer’s disease. Following the release of the initial results [1] from the estrogen/progestin arm of the trial (EPT-conjugated estrogen 0.625 mg/medroxyprogesterone 2.5 mg), sales of MHT products dropped precipitously, and women and providers were frightened to start or continue hormone therapy. Although the estrogen-only arm of the WHI trial (ET) released in 2004 [2] showed a reduction in breast cancer cases with conjugated estrogen 0.625 when used in hysterectomized women, fear of cardiovascular events remained a predominant deterrent against resurgent use of hormonal therapies. In 2007, Rossouw et al. [3] published the evaluation of the WHI with findings that MHT had differing effects depending on age and timing of initiation. Today, MHT remains the most effective treatment for vasomotor symptoms (VMS) [4] and other symptoms of the climacteric for postmenopausal women without contraindications (Table 4.1) [5]. We know now that benefits may exceed risks for the majority of symptomatic postmenopausal women who at the time of initiation of MHT are less than age 60 or less than 10 years since the onset of menopause and at low baseline risk for cardiovascular events [6]. In addition to timing and duration of therapy, there also appears to be differences in the risk/benefit profiles between different types of hormonal regimens, including formulation, dose, and route of administration [7–9]. Prior to initiating MHT, women should be screened for cardiovascular and breast cancer risk, and the most appropriate therapy should be recommended depending on benefit/risk profile, indications, and goals of therapy. Therapy should be individualized based on clinical issues including risk factors, treatment goals, and patient preference [7–9].

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Disclosures

J.V. Pinkerton (all fees to the University of Virginia) has served as a consultant for Pfizer and has received grants/research support from Therapeutics MD.

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Authors and Affiliations

  1. Division Director Midlife Health, University of Virginia Health System, 801104, Charlottesville, VA, 22908, USA

    JoAnn V. Pinkerton MD, NCMP

  2. The North American Menopause Society, Mayfield Heights, OH, USA

    JoAnn V. Pinkerton MD, NCMP

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Correspondence to JoAnn V. Pinkerton MD, NCMP .

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  1. Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Reproductive Endocrinology and Infertility Yale School of Medicine, New Haven, Connecticut, USA

    Lubna Pal

  2. Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts, USA

    Raja A. Sayegh

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Pinkerton, J.V. (2017). Pharmacotherapies for Menopause Management: Hormonal Options. In: Pal, L., Sayegh, R. (eds) Essentials of Menopause Management. Springer, Cham. https://doi.org/10.1007/978-3-319-42451-4_4

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