Complications
Vaginal bleeding is common in the first 4 to 6 months with estrogen and progestogen therapy. If necessary, more progestogen may be added to a continuous estrogen-progestogen regimen.
Changing to a cyclic combination regimen results in the woman having monthly withdrawal bleeding.
Persistent postmenopausal vaginal bleeding requires further investigation.
This is a complication of estrogen treatment. The dose of estrogen should be decreased.
Persistent symptoms require further investigation.
Observational studies and a meta-analysis indicate that transdermal estrogens are associated with a lower risk of venous thromboembolism (VTE) than oral estrogens.[1][50][51] The risk of VTE is higher if hormone therapy is initiated after age 60 years or more than 10 years from menopause onset.[17]
Hormone therapy with an estrogen alone is associated with little or no change in the risk of breast cancer.[1] An estrogen prescribed in combination with a progestin is associated with a small increase in the risk of breast cancer.[1][50][51][Evidence C] The increased risk is related to duration of treatment, and likely recedes after treatment is stopped.[1][50][51]
The risk of venous thromboembolism and ischemic stroke increases with oral hormone therapy, but the absolute risk of stroke in women under 60 years of age is very low.[1][50][51] Data on the risk of hemorrhagic stroke in women using hormone therapy are inconsistent and lacking.[20]
Observational studies and a meta-analysis indicate that transdermal estrogens are associated with a lower risk of venous thromboembolism and stroke than oral estrogens.[1][17][50][51]
Vaginal and urogenital epithelial thinning occurs with menopause and can lead to increased susceptibility to urinary tract infections. Vaginal (or systemic) estrogen replacement can improve the thickness and health of the perineal epithelium and lower the rate of recurrent urinary tract infections.
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