Highlights
- •Women with risk factors for cardiovascular disease may still be good candidates for hormone therapy.
- •Transdermal routes of hormone therapy are preferred for women with moderate to severe menopausal symptoms and cardiovascular risk factors.
- •The treatment of genitourinary syndrome of menopause with low-dose vaginal estrogen or other local vaginal therapy is safe in women with risk factors for cardiovascular disease and in women with a history of heart attack or stroke.
Abstract
Women with preexisting cardiovascular disease (CVD) or vascular risk factors commonly
experience bothersome symptoms of menopause, including vasomotor symptoms (VMS) and
genitourinary syndrome of menopause (GSM). Due to confusion surrounding the safety
of menopausal hormone therapy (HT) in symptomatic women with CVD, evidence-based guidelines
should be followed regarding identifying candidates for treatment and HT decision
making. This review summarizes best practices in the evaluation and treatment of VMS
and GSM in women with preexisting CVD, based on international expert consensus guidelines
and/or expert opinion when data are scarce.
For women with preexisting CVD or vascular risk factors who are candidates for HT,
guidelines often address the appropriate formulation, dose, and route of delivery.
For women who are not candidates for HT, non-hormonal options are reviewed, and their
safety and efficacy in treating VMS and GSM are discussed.
Due to increased knowledge of the role that pregnancy-related complications play in
maternal risk for future CVD, these conditions are considered when addressing the
use of systemic HT. Women at increased risk for future CVD without the use of HT,
such as women with premature or early menopause, are also discussed, as well as the
safely profile of HT in these special populations.
With worldwide rates of CVD increasing among women in midlife, it is important for
clinicians to have clear guidelines for identifying candidates for hormonal and nonhormonal
treatments for symptom management to safeguard the health and quality of life of these
patients through the menopause transition and post-menopause.
Keywords
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Article info
Publication history
Published online: January 26, 2022
Accepted:
January 22,
2022
Received in revised form:
January 17,
2022
Received:
May 10,
2021
Identification
Copyright
© 2022 Published by Elsevier B.V.
