All women should have access to advice so that they can make informed decisions about diet and lifestyle and treatment options to optimise their menopause transition and postmenopausal health.
HRT dosage, regimen and duration should be individualised, with annual evaluation of advantages and disadvantages.
Transdermal estradiol is unlikely to increase the risk of venous thrombosis or stroke above that of non-users and is associated with lower risk compared with oral estradiol.
Limited evidence suggests that micronised progesterone and dydrogesterone may be associated with lower risk of breast cancer and venous thrombosis compared to other progestogens.
Arbitrary limits should not be placed on the duration of use of HRT; if symptoms persist, the benefits usually outweigh the risks.
HRT prescribed before the age of 60 or within 10 years of the menopause has a favourable benefit /risk profile and is likely to be associated with a reduction in coronary heart disease and cardiovascular mortality.
If HRT is used in women over 60 years of age, low doses should be started, preferably with a transdermal estradiol preparation.
Women with POI should be encouraged to use hormonal therapy at least until the average age of the menopause. HRT or the combined contraceptive pill would be suitable. However, HRT may confer a more favourable improvement in bone density and cardiovascular markers compared with the combined contraceptive pill.
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Reviewed: December 2016 Next review date: December 2019