Risks and Benefits of MHT

Key Points

  • For the majority of symptomatic women, the benefits of menopausal hormone therapy (MHT) outweigh the risks.
  • Consider the risks and benefits of MHT in the individual prior to commencing treatment.
  • Aim to commence MHT within the first 10 years after menopause.
  • Consider the use of transdermal preparations to reduce the risk of thromboembolism.
  • Micronised progesterone and dydrogesterone may be associated with lower risks compared with other progestogens
  • There is no evidence of increased breast cancer risk with the use of vaginal oestrogen.

As medical practitioners, we are well aware of the benefits of MHT for the treatment of menopausal symptoms and maintenance of bone density. However, in discussing this with women, we may find that she is focused on the risks, real or perceived, of the treatment. It is therefore important to be able to discuss the risks and benefits in a way that is understandable to the individual woman.

pdfAMS Risks and Benefits of MHT 2021175.16 KB

Historical perspective

Subsequent analyses have refined and clarified the findings of the WHI. What is currently understood about the risks of MHT? 

Breast cancer

Extras cases of breast cancer per 10,000 women years for women using MHT compared to never use in two nested case control studies (10).

 
Extra cases of breast cancer per 10 000 women years
in MHT users vs never user by age group*
 
50-59
60-69
70-79
Oestrogen only
     
Recent use 1-5 years
3
4
8
Recent use ≥ 5 years
-
5
8
       
Oestrogen+progestogen
     
Past use 1-5 years
-
2
5
Past use ≥ 5 years
-
5
8
Recent use 1-5 years
9
15
19
Recent use ≥ 5 years
15
29
36

*Risk of adverse drug reaction <10/10,000 is considered ‘rare’ (9)

MHT and Cardiovascular disease

MHT and thromboembolic disease:

Supporting women in making a decision

AMS Empowering Menopausal Women

Note: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to a particular person's circumstances and should always be discussed with that person's own healthcare provider.

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Content Updated January 2021

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