Administration (Martin & Barbieri, 2023)

• Medications are typically taken on a continuous or cyclical schedule.

• Dosing begins low and then titrated to relieve symptoms.

• Vasomotor symptoms such as hot flashes require systemic estrogen.
• Genitourinary syndrome of menopause should be treated with low-dose vaginal estrogen, not systemic.
• Females with primary ovary insufficiency may require higher daily dosing.
• If hot flashes continue after four weeks of therapy, the estrogen dose may be increased.
• Once symptoms subside and the patient tolerates MHT, the medication regimen continues for three to five years before a taper is attempted.
  • For females with severe symptoms who start MHT in their late 40s, a taper is not attempted for at least five years.
• MHT is typically discontinued by the age of 60 when the risks outweigh the benefits. However, The Menopause Society and the American College of Obstetrics and Gynecology recommend that MHT be individualized and not stopped based only on patient age.

• Oral
  • Oral estrogens should generally be avoided in patients with hypertriglyceridemia, active gall bladder disease, or thrombophilia (e.g., factor V Leiden).
• Transdermal patch
• Topical gels, lotions, sprays
• Vaginal ring, tablet, cream

Common Adverse Effects of MHT (Harper-Harrison, Carlson & Shanahan, 2024; Martin & Barbieri, 2023)

Patients may experience adverse effects of HRT, but the effects may be mitigated by lowering the dose of estrogen or progestin. These effects include the following:

• Breast soreness
• Mood changes
• Fluid retention, bloating
• Vaginal bleeding
• Headache

PEARLS (Martin & Barbieri, 2023)

• HRT is considered safe for healthy, symptomatic patients within ten years of menopause or younger than 60 years. HRT isn’t usually started after the age of 60.
• HRT is no longer recommended to prevent chronic diseases such as coronary heart disease (CHD) or osteoporosis, to improve cognitive function, or to prevent dementia.
• Selective serotonin reuptake inhibitors (SSRIs) combined with HRT may alleviate significant mood changes.