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Menopausal Hormone Therapy to Prevent Chronic Conditions

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Postmenopausal Diseases and Disorders

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.

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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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  1. DIATROS, Clínica de Atención a la Mujer, Barcelona, Spain

    Rafael Sánchez-Borrego

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  1. Rafael Sánchez-Borrego
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  1. Department of Obstetrics and Gynecology, University of Zaragoza Facultad de Medicina, Zaragoza, Spain

    Faustino R. Pérez-López

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Sánchez-Borrego, R. (2019). Menopausal Hormone Therapy to Prevent Chronic Conditions. In: Pérez-López, F. (eds) Postmenopausal Diseases and Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-13936-0_22

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