Menopausal Hormone Therapy - Pros and Cons

Menopausal hormone therapy (MHT) is surrounded by controversies after the revolutionary reports from Women’s Health Initiative (WHI) trial in 2002. The universal hormone therapy (HT) policy used before WHI became obsolete after 2002. Majority of women who were already taking MHT discontinued the therapy worldwide. Even practitioners stopped prescribing MHT. Several studies have suggested a “timing hypothesis” or a “window-of-opportunity” for the initiation of MHT, which is early after menopause. This means that MHT is best given immediately postmenopause for a short duration of time. MHT started many years is best given immediately postmenopause for a short duration of time. MHT started many years after menopause and given for long duration following menopause has more side effects. The use of MHT decreased drastically after the results of these two studies were published. However, due to Danish Osteoporosis Prevention Study and the Kronos Early Estrogen Prevention Study, interest has been generated in MHT due to beneficial results of MHT. Excellent symptom relief can be provided by MHT for healthy women who experience menopausal symptoms. MHT poses a low risk in these healthy women with no comorbidities. With regard to cardiovascular diseases and osteoporosis, not giving MHT in symptomatic women may pose a risk. When MHT is initiated in elderly women and in those with comorbidities, it may be associated with increased risk. Prior discussion with patient about HT is a must before starting MHT. Personalized discussion with patient about symptoms, treatment goals, analysis of age, time since menopause, and consideration of comorbidities influences decision-making about starting MHT. We recommend further studies on MHT for better understanding of risk versus benefit of MHT.