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Menopausal Hormone Therapy to Prevent Chronic Conditions

  • Rafael Sánchez-BorregoEmail author
Chapter

Abstract

The most efficient approach for relief of the vasomotor symptoms of the menopause at any age comprises MHT based on estrogens (alone or in combination with progestogens), tibolone, and the combination of conjugated estrogens and bazedoxifene. Randomized placebo-controlled trials have demonstrated that low-dose vaginal estrogen, intravaginal dehydroepiandrosterone, and oral ospemifene effectively improve vaginal comfort and trophism. Findings from randomized clinical trials, as well as preclinical, clinical, and epidemiologic studies, clarify the favorable benefit-risk profile for MHT use by recently menopausal women (also known as the timing hypothesis) with bothersome vasomotor and related menopausal symptoms. The window-of-opportunity theory has been extended to other putative benefits of hormone therapy, including reducing dementia, improving cognition, and preventing mood disorders. However, supporting evidence is limited. We must emphasize the individualization and shared decision-making that facilitates the appropriate decisions regarding the use of MHT.

Keywords

Menopause Menopausal hormone therapy Vasomotor symptoms Cardiovascular disease Breast cancer Cognitive impairment Depression Dyspareunia Vaginal dryness 

Abbreviations

AD

Alzheimer’s disease

BC

Breast cancer

BMD

Bone mineral density

CE/BZA

Combination of conjugated estrogens and bazedoxifene

CHD

Coronary heart disease

CVD

Cardiovascular disease

E2

Estradiol

E4

Estetrol

E-MHT

Unopposed estrogen therapy

EP-MHT

Combined therapy of estrogen and progestogen

ER

Estrogen receptor

FSFI

Female Sexual Function Index

HR

Hazard ratio

HSDD

Hypoactive sexual desire disorder

KEEPS

Kronos Early Estrogen Prevention Study

LMP

Last menstrual period

LNG-IUS

Levonorgestrel-releasing intrauterine system

MHT

Menopausal hormone therapy

P4

Natural progesterone

POP

Pelvic organ prolapse

QoL

Quality of life

RCT

Randomized controlled trial

ROS

Reactive oxygen species

SERM

Selective estrogen receptor modulator

TSEC

Tissue-selective estrogen complex

VMS

Vasomotor symptoms

VTE

Venous thromboembolism

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.DIATROS, Clínica de Atención a la MujerBarcelonaSpain

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