Journal List > J Korean Med Assoc > v.62(3) > 1118965

Kwon and Shin: Updated treatment guideline for hormone therapy in postmenopausal women

Abstract

Since menopause hormone therapy was first introduced, it has been widely used worldwide as the most effective treatment for vasomotor symptoms in menopausal women and for genitourinary syndrome of menopause. Menopause hormone therapy has been shown to prevent bone loss and fracture, but it may additionally offer various benefits for numerous other symptoms. The benefit-to-risk ratio of menopause hormone therapy is most favorable for women aged younger than 60 years or who are within 10 years of menopause onset and have no contraindications. Longer durations of therapy should be limited to patients with documented indications, such as persistent vasomotor symptoms or bone loss. For genitourinary syndrome of menopause, low-dose vaginal estrogen therapy or other therapies are recommended. Tibolone is a synthetic steroid that provides a therapeutic effect in the treatment of menopausal symptoms.

Figures and Tables

Figure 1

Algorithm for menopausal symptom management and hormonal/non-hormonal therapy decision-making. SSRIS, selective serotonin reuptake inhibitors; SNRI, serotonin norepinephrine reuptake inhibitors.

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Table 1

Formulations and doses of estrogen for treatment of menopausal symptoms

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References

1. US Preventive Services Task Force. Grossman DC, Curry SJ, Owens DK, Barry MJ, Davidson KW, Doubeni CA, Epling JW Jr, Kemper AR, Krist AH, Kurth AE, Landefeld CS, Mangione CM, Phipps MG, Silverstein M, Simon MA, Tseng CW. Hormone therapy for the primary prevention of chronic conditions in postmenopausal women: US Preventive Services Task Force Recommendation Statement. JAMA. 2017; 318:2224–2233.
crossref pmid
2. Stuenkel CA, Davis SR, Gompel A, Lumsden MA, Murad MH, Pinkerton JV, Santen RJ. Treatment of symptoms of the menopause: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2015; 100:3975–4011.
crossref pmid
3. Maclennan AH, Broadbent JL, Lester S, Moore V. Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes. Cochrane Database Syst Rev. 2004; (4):CD002978.
crossref
4. Torgerson DJ, Bell-Syer SE. Hormone replacement therapy and prevention of nonvertebral fractures: a meta-analysis of randomized trials. JAMA. 2001; 285:2891–2897.
crossref pmid
5. Sullivan SD, Sarrel PM, Nelson LM. Hormone replacement therapy in young women with primary ovarian insufficiency and early menopause. Fertil Steril. 2016; 106:1588–1599.
crossref pmid pmc
6. Lethaby A, Ayeleke RO, Roberts H. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev. 2016; (8):CD001500.
crossref
7. Pinkerton JV, Abraham L, Bushmakin AG, Cappelleri JC, Racketa J, Shi H, Chines AA, Mirkin S. Evaluation of the efficacy and safety of bazedoxifene/conjugated estrogens for secondary outcomes including vasomotor symptoms in postmenopausal women by years since menopause in the Selective estrogens, Menopause and Response to Therapy (SMART) trials. J Womens Health (Larchmt). 2014; 23:18–28.
crossref pmid
8. Anderson GL, Judd HL, Kaunitz AM, Barad DH, Beresford SA, Pettinger M, Liu J, McNeeley SG, Lopez AM. Women's Health Initiative Investigators. Effects of estrogen plus progestin on gynecologic cancers and associated diagnostic procedures: the Women's Health Initiative randomized trial. JAMA. 2003; 290:1739–1748.
crossref pmid
9. Boothby LA, Doering PL, Kipersztok S. Bioidentical hormone therapy: a review. Menopause. 2004; 11:356–367.
crossref pmid
10. Atsma F, Bartelink ML, Grobbee DE, van der Schouw YT. Postmenopausal status and early menopause as independent risk factors for cardiovascular disease: a meta-analysis. Menopause. 2006; 13:265–279.
crossref pmid
11. Sarrel PM, Sullivan SD, Nelson LM. Hormone replacement therapy in young women with surgical primary ovarian insufficiency. Fertil Steril. 2016; 106:1580–1587.
crossref pmid pmc
12. Hong JS, Yi SW, Kang HC, Jee SH, Kang HG, Bayasgalan G, Ohrr H. Age at menopause and cause-specific mortality in South Korean women: Kangwha Cohort Study. Maturitas. 2007; 56:411–419.
crossref pmid
13. Heiss G, Wallace R, Anderson GL, Aragaki A, Beresford SA, Brzyski R, Chlebowski RT, Gass M, LaCroix A, Manson JE, Prentice RL, Rossouw J, Stefanick ML. WHI Investigators. Health risks and benefits 3 years after stopping randomized treatment with estrogen and progestin. JAMA. 2008; 299:1036–1045.
crossref pmid
14. Marjoribanks J, Farquhar C, Roberts H, Lethaby A, Lee J. Long-term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev. 2017; 1:CD004143.
crossref
15. Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society. Menopause. 2013; 20:888–902.
pmid
16. Cody JD, Jacobs ML, Richardson K, Moehrer B, Hextall A. Oestrogen therapy for urinary incontinence in postmenopausal women. Cochrane Database Syst Rev. 2012; 10:CD001405.
crossref
17. Joffe H, Petrillo LF, Koukopoulos A, Viguera AC, Hirschberg A, Nonacs R, Somley B, Pasciullo E, White DP, Hall JE, Cohen LS. Increased estradiol and improved sleep, but not hot flashes, predict enhanced mood during the menopausal transition. J Clin Endocrinol Metab. 2011; 96:E1044–E1054.
crossref
18. Yalamanchili V, Gallagher JC. Treatment with hormone therapy and calcitriol did not affect depression in older postmenopausal women: no interaction with estrogen and vitamin D receptor genotype polymorphisms. Menopause. 2012; 19:697–703.
crossref pmid pmc
19. Schmidt PJ, Nieman L, Danaceau MA, Tobin MB, Roca CA, Murphy JH, Rubinow DR. Estrogen replacement in perimenopause-related depression: a preliminary report. Am J Obstet Gynecol. 2000; 183:414–420.
crossref pmid
20. Barrett-Connor E, Wehren LE, Siris ES, Miller P, Chen YT, Abbott TA 3rd, Berger ML, Santora AC, Sherwood LM. Recency and duration of postmenopausal hormone therapy: effects on bone mineral density and fracture risk in the National Osteoporosis Risk Assessment (NORA) study. Menopause. 2003; 10:412–419.
crossref pmid
21. Min YK, Lee DY, Choi SJ, Kim JH, Choi D, Yoon BK. Effects of adding alendronate to ongoing hormone therapy on bone mineral density in postmenopausal Korean women: a randomized, double-blind, placebo-controlled clinical trial. Menopause. 2013; 20:761–766.
crossref pmid
22. Cummings SR, Ettinger B, Delmas PD, Kenemans P, Stathopoulos V, Verweij P, Mol-Arts M, Kloosterboer L, Mosca L, Christiansen C, Bilezikian J, Kerzberg EM, Johnson S, Zanchetta J, Grobbee DE, Seifert W, Eastell R. LIFT Trial Investigators. The effects of tibolone in older postmenopausal women. N Engl J Med. 2008; 359:697–708.
crossref pmid pmc
23. de Villiers TJ, Pines A, Panay N, Gambacciani M, Archer DF, Baber RJ, Davis SR, Gompel AA, Henderson VW, Langer R, Lobo RA, Plu-Bureau G, Sturdee DW. International Menopause Society. Updated 2013 International Menopause Society recommendations on menopausal hormone therapy and preventive strategies for midlife health. Climacteric. 2013; 16:316–337.
crossref pmid
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ORCID iDs

Dae-Hui Kwon
https://orcid.org/0000-0002-6010-0965

Jung-Ho Shin
https://orcid.org/0000-0001-7559-5457

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