Menopausal Hormone Therapy in women with other underlying diseases: how to proceed?

Postmenopausal women frequently suffer, in addition to classical climacteric symptoms, from other diseases. Therefore, it is important to know when, in which form, and with which dosage menopausal hormone therapy (MHT) may be prescribed with regard to the underlying chronic disease. All women's health specialists have to know when MHT is contraindicated. To minimize the risks of MHT in the presence of a chronic disease, the following basic rules should be kept in mind: If there is no absolute contraindication, MHT should be started within the "window of opportunity" (age < 60 years or within 10 years of menopause). Continuous transdermal administration has to be preferred; in the presence of most chronic diseases, a hepatic first pass effect should be avoided. The lowest efficient dosage should be selected because most side effects are dose dependent. Cyclical fluctuations of hormone blood levels should be avoided. Metabolically neutral progestagens, such as micronized progesterone, dydrogesterone and dienogest or transdermal administration of norethisterone acetate (NETA) should be chosen. Medroxyprogesterone acetate has to be avoided. If there are doubts, the treating physician should be contacted. Angiopathies (e.g., in arterial hypertension, diabetes mellitus, lupus erythomatodes) are an absolute contraindication for MHT. In the absence of angiopathies, transdermal MHT might be prescribed in women suffering from these diseases after an extensive risk-benefit evaluation and in agreement with the treating physician.