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For postmenopausal osteoporosis see Bone disorders section.

Hormone replacement therapy (HRT) is the most effective intervention for the management of quality-of-life symptoms associated with menopause. Symptoms of estrogen deficiency include hot flashes, sweating, insomnia, and vaginal dryness and discomfort.

Estrogen may be prescribed as monotherapy for women post-hysterectomy, while women with an intact uterus should have a progestational agent added to reduce the risk of endometrial hyperplasia and cancer. Dose selection must be individualized due to the great individual variability in dose response. Estrogens should be used at the lowest effective dose necessary to provide symptom relief or bone protection. Available formulations include oral tablets, transdermal patches, topical emulsions, injections, and vaginal preparations (eg, rings, tablets, creams).

Progesterone can be administered continuously or cyclically with estrogen, and should be taken at least 10–14 days each month in women with an intact uterus. Cyclic administration produces monthly menstrual periods. Continuous treatment produces amenorrhea, however some women may continue to experience breakthrough bleeding. A progestational agent can also be given every 3 months for 10–14 days to prevent endometrial trouble, thereby lessening the number of withdrawal bleeds.

The use of androgens in women has not been approved by the FDA. Data regarding the effects of androgen replacement therapy on sexual function in menopausal women are conflicting.

The Women's Health Initiative (WHI) study, a randomized primary prevention trial, revealed an increased risk of stroke, DVT, and probable dementia with estrogen monotherapy and an increased risk of myocardial infarction, stroke, invasive breast cancer, pulmonary emboli, DVT, and probable dementia in estrogen + progesterone combination therapy. Based on this data, it is recommended that estrogens should not be used to prevent cardiovascular disease or dementia. Because of the risks, estrogen, with or without progesterone, should be prescribed at the lowest effective dose for the duration necessary to achieve the desired therapeutic result based on individual treatment goals and risks.

The WHI has received scrutiny since being published. One major criticism was the age of the participants. The mean age at enrollment was 63.3 years with only 10% of the women being 50–54 years old. The majority of women enrolled were more than 10 years older than the age at which HRT is usually started. These older postmenopausal women were already at increased risk for cardiovascular disease. In addition, these women did not have severe postmenopausal symptoms as indicated for the use of HRT. Thus, the data cannot be applied to women in early menopause. Secondary analyses of findings from the WHI showed that the farther a woman was from the onset of menopause when she began HRT, the greater the risk of coronary heart disease due to HRT appeared to be.