Cited by 175Menopause: Health Impacts and TreatmentsEstrogen and related hormone effectsHormonal and reproductive studies

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Hormone Therapy in Menopause: Concepts, Controversies, and Approach to Treatment

Flores, Valerie A, Pal, Lubna, Manson, JoAnn E·2021·Endocrine Reviews

DOI 10.1210/endrev/bnab011

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Abstract

Hormone therapy (HT) is an effective treatment for menopausal symptoms, including vasomotor symptoms and genitourinary syndrome of menopause. Randomized trials also demonstrate positive effects on bone health, and age-stratified analyses indicate more favorable effects on coronary heart disease and all-cause mortality in younger women (close proximity to menopause) than in women more than a decade past menopause. In the absence of contraindications or other major comorbidities, recently menopausal women with moderate or severe symptoms are appropriate candidates for HT. The Women’s Health Initiative (WHI) hormone therapy trials—estrogen and progestin trial and the estrogen-alone trial—clarified the benefits and risks of HT, including how the results differed by age. A key lesson from the WHI trials, which was unfortunately lost in the posttrial cacophony, was that the risk:benefit ratio and safety profile of HT differed markedly by clinical characteristics of the participants, especially age, time since menopause, and comorbidity status. In the present review of the WHI and other recent HT trials, we aim to provide readers with an improved understanding of the importance of the timing of HT initiation, type and route of administration, and of patient-specific considerations that should be weighed when prescribing HT.

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Authors: Flores, V. A., Pal, L., & Manson, J. E.
Affiliations: Yale University (US)
Brigham and Women's Hospital (US)
Corresponding author: Flores, Valerie A
ORCID: Flores, Valerie A
Pal, Lubna
Manson, JoAnn E
Venue: Endocrine Reviews
Publisher: The Endocrine Society
Published: 2021-04-15
Volume: 42
Issue: 6
Pages: 720-752
ISSN: 0163-769X (ISSN-L)
1945-7189
DOI: 10.1210/endrev/bnab011
OpenAlex: W3155312871
Cited by: 174
References: 343
Citations by year: 2026: 40 · 2025: 45 · 2024: 44 · 2023: 30 · 2022: 13 · 2021: 2
FWCI: 3.45
Type: journal article
Language: en
Open access: closed
Licence: academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
Locations: Endocrine Reviews (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
Life Sciences › Biochemistry, Genetics and Molecular Biology › Endocrinology › Estrogen and related hormone effects
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
Keywords: hormone therapy, menopause, vasomotor symptoms, genitourinary syndrome of menopause, bone health, coronary artery disease, all-cause mortality, Women's Health Initiative, estrogen-progestin, estrogen-only therapy, timing of hormone therapy initiation, route of administration, risk-benefit assessment
MeSH terms: Estrogens, Female, Humans, Menopause, Estrogen Replacement Therapy, Women's Health, Hormone Replacement Therapy

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Hormone Therapy in Menopause: Concepts, Controversies, and Approach to Treatment

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