“If you do not have a uterus,
you can take estrogen alone,
without a progestogen”.1

Umbrella
What may the Hormone Therapy and Estrogen Therapy Umbrella include?

Depending on the Source (DotS) this Umbrella may include:

  • Estrogen Alone
  • Estrogen Therapy (ET)
  • Estrogen-Alone HRT/MHT
  • Hormone Replacement Therapy (HRT)
  • Hormone Therapy (HT)
  • Menopausal Hormone Therapy (MHT)
  • Oestrogen-Only HRT
  • Oestrogen-Only Therapy/Oestrogen Only Therapy
  • Systemic ET

No UterusHormone Therapy and Estrogen Therapy

Who may choose to use estrogen therapy (ET)?

On page two in Deciding About Hormone Therapy Use: Estrogen Alone or Estrogen Plus Progestogen, published July 2022, the North American Menopause Society (NAMS) note:

“If you do not have a uterus, you can take estrogen alone, without a progestogen”.2

On page one in HRT: Which HRT? Oestrogen Alone, published November 2021, the (British) Women’s Health Concern elaborate on:

“The core ingredient of all forms of HRT is oestrogen. Oestrogen relieves hot flushes and the other menopausal symptoms and maintains bone strength. This is suitable for women who have had a total hysterectomy, where the whole womb including its neck (cervix) has been removed. Oestrogen alone can be taken as a daily tablet, a weekly or twice weekly patch, a daily gel or an implant. Varying doses of oestrogen are available”.3

Formulations and Options

What are some ET formulations and options?

In The 2023 Practitioner’s Toolkit for Managing Menopause: Management – MHT Formulations and Options: Estrogen Therapy, published online 30 October 2023, the authors elaborate on:

“Estrogen can be used systemically as oral conjugated equine estrogen, estradiol valerate, estrone sulfate or micronized estradiol; transdermal estradiol (patches, gels, spray); a vaginal estradiol ring; and implanted estradiol pellets (mostly not regulator-approved). Vaginal pessaries and creams are used to treat urogenital symptoms”.4

Venous Thromboembolic Disease

What is the association between venous thromboembolic disease (VTE) and ET?

In The 2023 Practitioner’s Toolkit for Managing Menopause: Management – Considerations for All Women At Menopause: Menopausal Hormone Therapy the authors include:

  • “Oral estrogen is associated with an increased risk of venous thromboembolic disease (VTE), although the absolute risk is small for women aged <60 years. The risk is lower/not at all with transdermal estradiol, which is preferred for women at increased risk of VTE (i.e. smokers, obese women and diabetic women)”.5

Health Care Provider

If I choose to use ET what are my risks?

Different women who choose to use ET can have different risks. It may therefore be in your best interest to choose to talk to your health care provider about this.

If I choose to use estrogen plus progestogen (EPT) what are my risks?

Different women who choose to use EPT can have different risks. It may therefore be in your best interest to also choose to talk to your health care provider about this.

On page two in the Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause first published online 10 June 2022, one of the recommendations is:

  • “The decision whether to take HRT, the dose and duration of its use should be made on an individualised basis after discussing the benefits and risks with each patient. This should be considered in the context of the overall benefits obtained from using HRT including symptom control and improving quality of life as well as considering the bone and cardiovascular benefits associated with HRT use”.6

On page one in Deciding About Hormone Therapy Use: Estrogen Alone or Estrogen Plus Progestogen, the NAM explain:

“Every woman is different, and you will decide about whether to use HT based on the severity of your symptoms, your personal and family health history, and your own beliefs about menopause treatments. Your healthcare professional will be able to help you with your decision”.7

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Sources

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Sources

  1. Deciding About Hormone Therapy Use: Estrogen Alone or Estrogen Plus Progestogen. 2022:2. North American Menopause Society https://www.menopause.org/docs/default-source/professional/menonote-deciding-about-ht-2022.pdf Accessed: 31 March 2024
  2. Deciding About Hormone Therapy Use: Estrogen Alone or Estrogen Plus Progestogen. 2022:2. North American Menopause Society https://www.menopause.org/docs/default-source/professional/menonote-deciding-about-ht-2022.pdf Accessed: 31 March 2024
  3. HRT: Which HRT? Oestrogen Alone. November 2021: 1. Women’s Health Concern https://www.womens-health-concern.org/wp-content/uploads/2022/12/09-WHC-FACTSHEET-HRT-NOV2022-B.pdf Accessed: 31 March 2024
  4. Davis, S. R., Taylor, S., Hemachandra, C., Magraith, K., Ebeling, P. R., Jane, F., and Islam, R. M. The 2023 Practitioner’s Toolkit for Managing Menopause: Management – MHT Formulations and Options: Estrogen Therapy. Published Online: 30 October 2023 https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783 Accessed: 31 March 2024
  5. Davis, S. R., Taylor, S., Hemachandra, C., Magraith, K., Ebeling, P. R., Jane, F., and Islam, R. M. The 2023 Practitioner’s Toolkit for Managing Menopause: Management – Considerations for All Women At Menopause: Menopausal Hormone Therapy. Published Online: 30 October 2023 https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783 Accessed: 31 March 2024
  6. Hamoda, H., Mukherjee, A., Morris, E., Baldeweg, S. E., Jayasena, C. N., Briggs, P., Moger, S. Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause. First Published Online 10 June 2022:3-4. https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 31 March 2024
  7. Deciding About Hormone Therapy Use: Estrogen Alone or Estrogen Plus Progestogen. 2022:1. North American Menopause Society https://www.menopause.org/docs/default-source/professional/menonote-deciding-about-ht-2022.pdf Accessed: 31 March 2024
Topic Last Updated: 01 June 2024 – Topic Last Reviewed: 31 March 2024

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