Menopausal hormone therapy: A safety perspective

Menopausal hormone therapy (MHT) is an effective treatment for menopausal symptoms and reduces the risk of fracture. However, use results in a net increase in the risk of certain potentially life-threatening conditions including breast cancer, stroke, ovarian cancer and venous thromboembolism, and, additionally, use of oestrogen-only MHT increases the risk of endometrial cancer in women with a uterus. Overall risks increase with increasing duration of use and with age and are greater for oestrogen-progestagen MHT than for oestrogen-only MHT. Increasing availability and consistency of data on the risks and benefits of MHT has been accompanied by agreement between key drug regulatory authorities that use should be targeted for moderate to severe menopausal symptoms only, and not for the prevention of disease. Key strategies for minimising MHT-associated risks are consistent with advice from drug regulatory agencies and include the following: MHT should be used for the short term treatment of menopausal symptoms (e.g. hot flushes, night sweats, vaginal dryness) only; women considering use of MHT should be informed of its risks and benefits; MHT should not be used for the prevention of disease, or (e.g. in Europe and Australia) as first line treatment for osteoporosis; MHT should be used for as short a period of time as possible and the need for continuing use should be reviewed six-monthly or annually. Preferential use of oestrogen-only MHT and transdermal oestrogen-only MHT, including judicious use in women with a uterus, is also likely to reduce MHT-associated risks, compared to use of oestrogen-progestagen MHT and oral MHT.