Evaluation and management of the hormone replacement therapy (HRT) candidate

As knowledge about menopause and hormone replacement therapy (HRT) has increased, it has become evident that a considerably higher percentage of postmenopausal women than the 20% to 30% currently treated could receive HRT. It is equally clear, however, that HRT is not appropriate for every woman and that ''one size fits all'' management of menopausal women is not always suitable. This paper, therefore, reviews published prescribing and management guidelines for instituting and maintaining HRT and summarizes current information concerning factors to be considered before recommending HRT. When choosing candidates, special attention should be placed on individual patient factors. A thorough history is required to determine the presence of contraindications and the likelihood of potential benefits and risk factors. The hormone replacement regimen, hormone preparations, and dosage forms that best meet the specific needs of the individual woman should be offered. Before undertaking long-term therapy, the candidate should be informed of the established and likely benefits and the relative risks of hormone therapy, and that the magnitude of some risks has not yet been definitively determined. The final decision to use therapy should be made by the patient, guided by her physician, and based on her current symptoms and her relative likelihood of developing coronary artery disease, osteoporotic fractures, and cancer. The ancillary benefits, the common side effects of each regimen, the bleeding patterns to expect, and the type and frequency of clinical monitoring that will be necessary during therapy should also be considered.