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  • Review Article
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Postmenopausal hormone therapy: risks and benefits

Nature Reviews Endocrinology volume 9, pages 216–227 (2013)Cite this article

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Abstract

Postmenopausal hormone therapy (PMHT) is used for the relief of menopausal symptoms, but the dosage has varied greatly throughout its existence. By the end of the 1990s, PMHT was mainly used to prevent chronic diseases such as osteoporosis, coronary heart disease and dementia, and large prevention trials were undertaken in this context. Following the initial negative reports of these trials, use of PMHT dramatically decreased. These reports noted surprisingly increased risks, notably of coronary heart disease, stroke and breast cancer, in people who used PMHT. Nowadays, considering the currently available data, it seems that an important distinction should be made between the treatment of climacteric symptoms in young, generally healthy, postmenopausal women and the prevention of chronic diseases in elderly women. PMHT seems to be beneficial and safe for postmenopausal symptomatic women aged <60 years. Treatments with a high safety profile should be the preferred option, including low-dose PMHT, oestrogen-only therapy in women who have had a hysterectomy, and vaginal oestrogen therapy for women with atrophic vaginitis. Nonandrogenic progestin might have a reduced thrombotic and breast cancer risk, and transdermal oestrogen could have a reduced thrombotic risk. Nevertheless, PMHT should not be used for the prevention of chronic diseases in the elderly (>70 years old) owing to the increased risk of stroke and breast cancer in these patients.

Key Points

  • Postmenopausal hormone therapy (PMHT) is indicated for the relief of menopausal symptoms in patients aged <60 years with climacteric symptoms

  • Low doses of PMHT should be used when possible

  • PMHT can be prescribed for a short period of time to treat osteoporosis when nonoestrogen therapies are unsuitable or in women who suffer simultaneously from climacteric symptoms and osteoporosis

  • Use of a sequential progestin and a nonandrogenic progestin might be safer than use of continuous androgenic progestin

  • Although data suggest that oestrogen therapy might prevent coronary heart disease, dementia and Alzheimer disease in young women, PMHT is not indicated for prevention of these conditions

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Acknowledgements

Research funding received from Amgen, IRIS, King Baudouin Foundation, MSD and Vesale research Foundation.

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  1. Department of Obstetrics & Gynaecology, CHU Saint-Pierre, Université Libre de Buxelles, 322 rue Haute, Brussels, 1000, Belgium

    Serge Rozenberg, Jean Vandromme & Caroline Antoine

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  1. Serge Rozenberg
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Contributions

S. Rozenberg researched data for the article, contributed to discussion of the content, wrote the article and reviewed/edited the manuscript before submission. J. Vandromme and C. Antoine contributed to discussion of the content and reviewed/edited the manuscript before submission.

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Correspondence to Serge Rozenberg.

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Competing interests

S. Rozenberg has been a speaker for Abbot, Amgen, MSD, Pfizer, Will Pharma and Servier and an advisory board member for Abbot, Amgen, MSD and Pfizer. The other authors declare no competing interests.

Supplementary information

Supplementary Table 1

Tools for evaluating risk of developing diseases associated with PMHT (DOC 59 kb)

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Rozenberg, S., Vandromme, J. & Antoine, C. Postmenopausal hormone therapy: risks and benefits. Nat Rev Endocrinol 9, 216–227 (2013). https://doi.org/10.1038/nrendo.2013.17

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