What is the role of estrogen therapy in the treatment of menopausal symptoms?

Updated: Oct 16, 2018
  • Author: Janice L Bacon, MD; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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Although decreasing estrogen levels alone do not cause all menopausal symptoms, estrogen—with or without progestogen (progesterone, progestin)—has been prescribed for many years to manage menopause. Estrogen was often prescribed to help alleviate symptoms of menopause, as well as to prevent cardiovascular disease (CVD) and osteoporosis.

Some have recommended that the term hormone replacement therapy (HRT) in menopause be changed to hormone therapy (HT) or menopausal hormone therapy (MHT), to reflect the shift in focus from replacing hormones to using them for symptomatic relief. [1]

The Clinical Practice Guidelines of the Endocrine Society, 2015, note that for menopausal women < 60 years of age or < 10 years post menopause with bothersome vasomotor symptoms (VMS) (with or without additional symptoms) who do not have a contraindication  or excess risk of cardiovascular disease (CVD) or breast cancer and who are willing to take menopausal hormone therapy (MHT)- that estrogen therapy or estrogen and progestin therapy ( for women with an intact uterus) be initiated.

The US Food and Drug Administration (FDA) has approved hormone therapy (HT) for four indications: bothersome VMS, prevention of bone loss, genitourinary symptoms and estrogen deficiency caused by hypogonadism, premature surgical menopause or premature ovarian insufficiency (POI). This does not encompass the management of POI in young or adolescent women which requires different management protocols.

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