This handout is for menopause & vasomotor-symptom management (mht & non-hormonal). Your care team identified this based on: hot flushes / night sweats (vasomotor symptoms) in a midlife woman (nams ht 2022).
Other reasons your team may use this plan: vaginal dryness / dyspareunia / urinary symptoms — genitourinary syndrome of menopause (nams gsm 2020); cycle-length variability / skipped periods (menopausal transition) (straw+10 harlow 2012); established mht review / annual benefit-risk re-evaluation / de-prescribing visit (nams ht 2022).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| estradiol (transdermal patch / gel / spray) | lowest effective transdermal dose (e.g. 25–50 mcg/24h patch), titrate to symptom control | transdermal | patch twice weekly / gel daily | NAMS HT 2022 — transdermal estrogen carries LOWER VTE/stroke signal than oral (no first-pass thrombotic activation); preferred route when any thrombotic/migraine/metabolic modifier present. rxcui 4096 = estradiol (in-repo validated, uro vaginal-estrogen dossiers); transdermal MHT-specific product code OMITTED (no in-repo precedent) |
| estradiol / conjugated equine estrogens (oral) | lowest effective oral dose (e.g. estradiol 1 mg or CEE 0.3–0.625 mg daily) | PO | once daily | NAMS HT 2022 — effective for VMS; WHI used CEE 0.625 mg (PMID 12117397: CHD HR 1.29 [1.02–1.63], stroke 1.41 [1.07–1.85], PE 2.13 [1.39–3.25] at mean age 63 — drove the timing reinterpretation). Reserve oral when no thrombotic/metabolic modifier. rxcui OMITTED — no in-repo precedent for oral estradiol/CEE MHT products |
| micronized progesterone | 100 mg nightly (continuous-combined) or 200 mg ×12–14 d/mo (sequential) | PO | nightly or cyclical | NAMS HT 2022 — endometrial protection is MANDATORY with systemic estrogen when a uterus is present; micronized progesterone preferred for the breast/metabolic profile vs MPA. ELITE used vaginal micronized progesterone with oral E2 if uterus (PMID 35474254). rxcui OMITTED — no in-repo precedent |
| medroxyprogesterone acetate / LNG-IUS (alternative progestogens) | MPA 2.5 mg daily (continuous) or LNG-IUS 52 mg in situ | PO or intrauterine | daily or in situ (LNG-IUS up to 5 y) | NAMS HT 2022 — alternative endometrial-protection progestogens; WHI CEE+MPA arm (PMID 12117397) is the canonical absolute-risk dataset; LNG-IUS gives local endometrial protection with the lowest systemic progestogen exposure. rxcui OMITTED — no in-repo precedent for medroxyprogesterone (consistent with gyn.abnormal-uterine-bleeding.core.v1) |
| tibolone (where available — synthetic STEAR) | 2.5 mg daily | PO | once daily | NAMS HT 2022 / IMS — single-agent option (not available in the US); not for women with prior breast cancer (increased recurrence). rxcui OMITTED — no in-repo precedent |
Plan: Systemic menopausal hormone therapy — timing-hypothesis × route × mandatory-progestogen gated (NAMS HT 2022 PMID 35797481)
Use these zones to know what to do based on how you feel.
Call 911 or go to the nearest emergency room right away if you have:
Long-term: there is no fixed mandatory stop date — continue for documented persistent VMS with shared decision-making and periodic re-evaluation; attempt taper/withdrawal trials and reassess. Bone health → cross-ref endo.osteoporosis.core.v1 (MHT is bone-protective but not first-line solely for bone if >60 y). Perimenopausal contraception transition (still fertile until 12 mo amenorrhoea / age ~55) → gyn.contraception-management.core.v1. CV risk modification; breast-cancer surveillance; return precautions (new bleeding, breast change, focal neurology, calf swelling) (NAMS HT 2022; Heiss 2008 PMID 18319414)
Guideline: 2022 NAMS Hormone Therapy Position Statement + 2023 NAMS Nonhormone Therapy Position Statement + 2020 NAMS Genitourinary Syndrome of Menopause Position Statement; STRAW+10 (Harlow 2012); NICE NG23; ACOG / Endocrine Society / IMS aligned