Hormone therapy has been used in postmenopausal women for decades in clinical practice. With further analysis and newer studies, the benefits and risks of hormone therapy have been repeatedly verified and discussed. Hormone therapy is recommended for the treatment of vasomotor symptoms (VMS), genitourinary syndrome of menopause (GSM) and the prevention of osteoporosis. However, the precise association between hormone therapy and the risks of cardiovascular diseases, venous thromboembolism, neurodegenerative diseases, breast cancer, and endometrial cancer remains controversial.
Therefore, determining how to take advantage of and control the risks of hormone therapy by adjusting the initiation time, regimen, and duration is crucial. Recent studies have indicated that hormone therapy is not related to the risk of all-cause, cardiovascular, or breast cancer mortality although it might increase the incidence of some chronic diseases. For symptomatic postmenopausal women under the age of 60 without contraindications, early initiation of hormone therapy is safe and probably has a mortality benefit over the long term. Initiating HT close to menopause at the lowest effective dose is more likely to have maximal benefits and the lowest risks.
Transdermal and vaginal hormone therapy may have a lower risk, but recent evidence suggests additional clinical benefits of oral hormone therapy formulations in relieving VMS and preventing osteoporosis. The pooled cohort risk equation for atherosclerotic cardiovascular disease (ASCVD) and the free app named Menopro can be used to perform individual risk assessments. In addition, Chinese herbal medicines have benefits in alleviating hot flashes, depression, and menopausal symptoms, although further data are needed to strongly support their efficacy.
Acupuncture and electroacupuncture have definite efficacy in the treatment of postmenopausal symptoms with few adverse effects, so they are a reasonable option as an alternative therapy for high-risk women.