A Review of Hormone and Non-Hormonal Therapy Options for the Treatment of Menopause

Abstract

Tracy E Madsen,1,2 Talia Sobel,3 Seraphina Negash,2 Tara Shrout Allen,4 Marcia L Stefanick,5 JoAnn E Manson,6 Matthew Allison7 1Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA; 2Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; 3Division of Women’s Health Internal Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA; 4Division of Preventive Medicine, University of California San Diego, San Diego, CA, USA; 5Department of Medicine, Stanford University, Stanford, CA, USA; 6Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA; 7Department of Family Medicine, University of California San Diego, San Diego, CA, USACorrespondence: Tracy E Madsen, Email [email protected]: Understanding the role of both menopausal hormone therapy (MHT) along with non-hormonal options for the treatment of vasomotor symptoms, sleep disruption, and genitourinary symptoms after menopause is critical to the health of women during middle and later life. Recent updates to the evidence for the treatment of menopausal symptoms pertaining to both hormonal and non-hormonal therapies as well as updated guidance from specialty societies can help guide clinicians in their treatment of women going through natural menopause or with estrogen deficiencies due to primary ovarian insufficiency or induced menopause from surgery or medications. The objective of this narrative review is to provide clinicians with an overview of MHT for the use of menopausal symptoms in women, incorporating updated primary evidence for risk versus benefit profiles, recent specialty society recommendations, and alternative, non-hormonal options. In this review, we summarize literature on the use of MHT for menopause-related symptomatology including options for formulations and dosages of MHT, non-hormonal treatment options, and the risk–benefit profile of MHT including long-term health consequences (eg, cardiovascular disease, cognitive decline, venous thromboembolism, and fracture risk). Finally, we highlight areas in which future research is needed to advance care of women after menopause. In summary, both hormonal (MHT) and non-hormonal options exist to treat symptoms of menopause. There is strong evidence for safety and effectiveness of MHT for the treatment of vasomotor symptoms among women who are less than 60 years of age, less than 10 years since menopause, and without significant cardiometabolic comorbidities. For others, treatment with hormonal versus non-hormonal therapies can be considered based on individual risk profiles, as well as other factors such as drug formulation, therapeutic goals, and symptom severity.Keywords: menopause, hormone therapy, cardiovascular disease, stroke

Keywords

• menopause
• hormone therapy
• cardiovascular disease
• stroke