Editing Menopause (section)

=== Menopausal hormone therapy ===
{{Main|Hormone replacement therapy}}
In the context of the menopause, [[menopausal hormone therapy]] (MHT) is the use of [[estrogen]] in women without a uterus and estrogen plus [[progestogen]] in women who have an intact uterus.<ref>The Woman's Health Program Monash University, [http://med.monash.edu.au/sphpm/womenshealth/docs/postmenopausal-hormone-therapy.pdf Oestrogen and Progestin as Hormone Therapy] {{webarchive|url=https://web.archive.org/web/20120711003526/http://med.monash.edu.au/sphpm/womenshealth/docs/postmenopausal-hormone-therapy.pdf|date=11 July 2012}}</ref>

MHT may be reasonable for the treatment of menopausal symptoms, such as hot flashes.<ref>{{cite journal |author=North American Menopause Society |date=March 2010 |title=Estrogen and progestogen use in postmenopausal women: 2010 position statement of The North American Menopause Society |journal=Menopause |volume=17 |issue=2 |pages=242–255 |doi=10.1097/gme.0b013e3181d0f6b9 |pmid=20154637 |s2cid=24806751}}</ref> It is the most effective treatment option, especially when delivered as a skin patch.<ref name="HRT20172">{{cite journal |author1=North American Menopause Society |date=March 2012 |title=The 2012 hormone therapy position statement of: The North American Menopause Society |journal=Menopause |volume=19 |issue=3 |pages=257–71 |doi=10.1097/GME.0000000000000921 |pmc=3443956 |pmid=22367731}}</ref><ref>{{cite journal |vauthors=Sarri G, Pedder H, Dias S, Guo Y, Lumsden MA |date=September 2017 |title=Vasomotor symptoms resulting from natural menopause: a systematic review and network meta-analysis of treatment effects from the National Institute for Health and Care Excellence guideline on menopause |url=http://eprints.gla.ac.uk/138525/7/138525.pdf |journal=BJOG |volume=124 |issue=10 |pages=1514–1523 |doi=10.1111/1471-0528.14619 |pmid=28276200 |s2cid=206909766}}</ref> Its use, however, appears to increase the risk of [[stroke]]s and [[blood clots]].<ref name="boardman20152">{{cite journal |vauthors=Boardman HM, Hartley L, Eisinga A, Main C, Roqué i Figuls M, Bonfill Cosp X, Gabriel Sanchez R, Knight B |date=March 2015 |title=Hormone therapy for preventing cardiovascular disease in post-menopausal women |journal=The Cochrane Database of Systematic Reviews |volume=2015 |issue=3 |pages=CD002229 |doi=10.1002/14651858.CD002229.pub4 |pmid=25754617 |pmc=10183715 |hdl-access=free |hdl=20.500.12105/9999}}</ref> When used for menopausal symptoms the global recommendation is MHT should be prescribed for a long as there are defined treatment effects and goals for the individual woman.<ref name="auto2" />

MHT is also effective for preventing bone loss and [[Osteoporosis|osteoporotic]] fracture,<ref>{{cite journal |vauthors=de Villiers TJ, Stevenson JC |date=June 2012 |title=The WHI: the effect of hormone replacement therapy on fracture prevention |journal=Climacteric |volume=15 |issue=3 |pages=263–6 |doi=10.3109/13697137.2012.659975 |pmid=22612613 |s2cid=40340985}}</ref> but it is generally recommended only for women at significant risk for whom other therapies are unsuitable.<ref name=":22">{{cite journal |vauthors=Marjoribanks J, Farquhar C, Roberts H, Lethaby A, Lee J |date=January 2017 |title=Long-term hormone therapy for perimenopausal and postmenopausal women |journal=The Cochrane Database of Systematic Reviews |volume=1 |issue=1 |pages=CD004143 |doi=10.1002/14651858.CD004143.pub5 |pmc=6465148 |pmid=28093732}}</ref>

MHT may be unsuitable for some women, including those at increased risk of cardiovascular disease, increased risk of thromboembolic disease (such as those with obesity or a history of venous thrombosis) or increased risk of some types of cancer.<ref name=":22" /> There is some concern that this treatment increases the risk of breast cancer.<ref name="ChlebowskiAnderson20152">{{cite journal |vauthors=Chlebowski RT, Anderson GL |date=April 2015 |title=Menopausal hormone therapy and breast cancer mortality: clinical implications |journal=Therapeutic Advances in Drug Safety |volume=6 |issue=2 |pages=45–56 |doi=10.1177/2042098614568300 |pmc=4406918 |pmid=25922653}}</ref> Women at increased risk of cardiometabolic disease and VTE may be able to use transdermal estradiol which does not appear to increase risks in low to moderate doses.<ref name="auto2" />

Adding [[testosterone]] to hormone therapy has a positive effect on sexual function in postmenopausal women, although it may be accompanied by hair growth or acne if used in excess. Transdermal testosterone therapy in appropriate dosing is generally safe.<ref>{{cite journal |display-authors=6 |vauthors=Davis SR, Baber R, Panay N, Bitzer J, Cerdas Perez S, Islam RM, Kaunitz AM, Kingsberg SA, Lambrinoudaki I, Liu J, Parish SJ, Pinkerton J, Rymer J, Simon JA, Vignozzi L, Wierman ME |date=October 2019 |title=Global Consensus Position Statement on the Use of Testosterone Therapy for Women |journal=Climacteric |volume=22 |issue=5 |pages=429–434 |doi=10.1080/13697137.2019.1637079 |pmid=31474158 |s2cid=201713094 |doi-access=free|hdl=2158/1176450 |hdl-access=free }}</ref>