Menopausal hormone therapy

Hormone replacement therapy (HRT), also known as menopausal hormone therapy (MHT) or postmenopausal hormone therapy (PHT, PMHT), is a form of hormone therapy used to treat symptoms associated with female menopause. These symptoms can include hot flashes, vaginal atrophy, accelerated skin aging, vaginal dryness, decreased muscle mass, sexual dysfunction, and bone loss. They are in large part related to the diminished levels of sex hormones that occur during menopause. Hormone replacement therapy (HRT), also known as menopausal hormone therapy (MHT) or postmenopausal hormone therapy (PHT, PMHT), is a form of hormone therapy used to treat symptoms associated with female menopause. These symptoms can include hot flashes, vaginal atrophy, accelerated skin aging, vaginal dryness, decreased muscle mass, sexual dysfunction, and bone loss. They are in large part related to the diminished levels of sex hormones that occur during menopause. The main hormonal medications used in HRT for menopausal symptoms are estrogens and progestogens, among which progesterone is the major naturally-occurring female sex hormone and also a manufactured medication used in menopausal hormone therapy. Though both can have symptomatic benefits, progestogen is specifically added to estrogen regimens when the uterus is still present. Unopposed estrogen therapy promotes endometrial thickening and can increase the risk of cancer, while progestogen reduces this risk. Androgens like testosterone are sometimes used as well. HRT is available through a variety of different routes. The results of the Women's Health Initiative (WHI) suggest both potential risks and benefits across different organ systems. Long term follow up of the WHI participants, however, has found no difference in all-cause, cardiovascular, or cancer mortality with HRT. Later studies suggested that risk can differ depending on route of administration. 'Bioidentical' hormone replacement – a development in the 21st century using manufactured compounds having 'exactly the same chemical and molecular structure as hormones that are produced in the human body', and are based mainly on steroids from plants – has inadequate clinical research to determine its efficacy and safety, as of 2017. The current indications for use from the United States Food and Drug Administration (FDA) include short-term treatment of menopausal symptoms, such as vasomotor hot flashes or vaginal atrophy, and prevention of osteoporosis. Approved uses of HRT in the United States include short-term treatment of menopausal symptoms such as hot flashes and vaginal atrophy, and prevention of osteoporosis. The American College of Obstetrics and Gynecology (ACOG) approves of HRT for symptomatic relief of menopausal symptoms, and advocates its use beyond the age of 65 in appropriate scenarios. The North American Menopause Society (NAMS) 2016 annual meeting mentioned that HRT may have more benefits than risks in women before the age of 60. A consensus expert opinion published by The Endocrine Society stated that when taken during perimenopause or the initial years of menopause, HRT carries fewer risks than previously published, and reduces all cause mortality in most scenarios. The American Association of Clinical Endocrinologists (AACE) has also released position statements approving of HRT in appropriate scenarios. Women receiving this treatment are usually post-, peri-, or surgically menopausal. Menopause is the permanent cessation of menstruation resulting from loss of ovarian follicular activity, defined as beginning twelve months after the final natural menstrual cycle. This twelve month time point divides menopause into early and late transition periods known as 'perimenopause' and 'postmenopause'. Premature menopause can occur if the ovaries are surgically removed, as can be done to treat ovarian or uterine cancer. The Women's Health Initiative (WHI) was a study of over 27,000 women beginning in 1991. Successive analyses have found sometimes contradictory results, with the most recent publication in 2017 finding no difference for all cause mortality with HRT. The effects of HRT on most organ systems vary by age and time since the last physiological exposure to hormones, and there can be differences in individual regimens, factors which have made analyzing effects difficult. Demographically, the vast majority of data available is in postmenopausal American women with concurrent pre-existing conditions, and with a mean age of over 60 years. HRT is often given as a short-term relief from menopausal symptoms during perimenopause. Potential menopausal symptoms include: