Background
Women have an increasing number of options, both hormonal and non-hormonal, for the management of menopausal symptoms. A major deterrent to treatment, however, is the complexity of the decision-making process and the lack of information about available options. This new algorithm and mobile app for menopausal symptom management incorporate state-of-the-science evidence and research to clarify and streamline the decision-making process for both patients and clinicians.
Menopausal HT continues to have an important clinical role in the management of vasomotor and other menopausal symptoms, but it has complex biological effects. The rational use of HT requires balancing the potential benefits and risks of treatment. Although findings from the Women's Health Initiative (WHI) and other randomized clinical trials have helped to clarify the benefits and risks of HT and provided insights to improve decision making, current options include lower doses and transdermal formulations that may further minimize risks. Available research suggests that risk stratification based on clinical characteristics of the patient has utility in identifying those for whom benefits of HT are likely to outweigh the risks. Age and time since menopause are strong predictors of health outcomes on HT, and the absolute risks of adverse events are much lower in younger than older women (see Figure 2). Differences by age have been particularly apparent for estrogen alone among women with hysterectomy. In addition, women at higher baseline cardiovascular risk, due to dyslipidemia, metabolic syndrome, or other cardiometabolic risk factors, have greater risk of adverse vascular outcomes on HT than women at lower risk. These findings, based on proximity to menopause, underlying cardiovascular risk, and other personal risk factors, have been incorporated into the decision-making process used in this algorithm. Women who are not candidates for, or do not choose to take, HT can be evaluated for non-hormonal treatments. The use of risk stratification and personalized risk assessment offers promise for improved safety and a more favorable benefit:risk profile for both hormonal and non-hormonal treatments.
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Figure 2.
WHI hormone therapy trials: absolute risks (cases per 10,000 person-years) for outcomes in the intervention phases of the estrogen-progestin and estrogen-alone trials, by age group. Data are from reference 4.