What are the forms of menopausal hormone replacement therapy (HRT)?

Updated: Sep 13, 2021
  • Author: Nicole K Banks, MD; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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HT can be prescribed as local or systemic therapy, as follows:

  • Local preparations - Creams, pessaries, rings

  • Systemic formulations - Oral drugs, transdermal patches and gels, implants

Liver bypass of the hormones is achieved with transdermal preparations and implants, which help to ensure predictable and optimal serum levels.

Hormonal products available in the preparations listed may contain the following ingredients:

  • Estrogen alone

  • Combined estrogen and progestogen

  • Selective estrogen receptor modulator (SERM)

  • Gonadomimetics, such as tibolone, which contain estrogen, progestogen, and an androgen

The various schedules of hormone therapy include the following:

  • Estrogen taken daily

  • Cyclic or sequential regimens in which progestogen is added for 10-14 days every 4 weeks

  • Continuous combined regimens in which estrogen and progestogen are taken daily

The estrogens most commonly prescribed are conjugated estrogens that may be equine (CEE) or synthetic, micronized 17β estradiol, and ethinyl estradiol. The progestins that are used commonly are medroxyprogesterone acetate (MPA) and norethindrone acetate.

The dosage varies but the most commonly prescribed HT is combined estrogen and progestin in the form of 0.625 mg/d CEE with 2.5 mg/d MPA in women with an intact uterus. Lower dose preparations that contain 1.5 mg/d of MPA with either 0.45 mg or 0.3 mg/d of CEE are becoming increasingly popular.

Estrogen is used alone in women who have undergone hysterectomy. Treatment should be initiated with the lowest possible dosage and then titrated based on clinical response.

SERMS are a class of nonhormonal drugs that selectively mimic or antagonize the effect of estrogen at various target organ sites. They have beneficial effects on bone and cholesterol metabolism and can be offered as an alternative to traditional HT for prevention and treatment of osteoporosis in postmenopausal women.

For related information, see Medscape CME Activity, NAMS Updates Guidelines on Postmenopausal Hormone Therapy.

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