Individualizing hormone therapy: Weighing risks and benefits

Age at HT initiation

HT dosage

A second important influence on the HT risk-benefit profile is the dose of estrogen and progestin. Evidence is substantial that low-dose HT is effective in preventing bone loss and treating menopausal symptoms with less bleeding and other side effects than higher doses.^12-14 More important, lower doses are also associated with lower risks.

The Nurses' Health Study (NHS) was a prospective, observational cohort study of 70,533 postmenopausal women that investigated duration, dose, and type of HT in preventing cardiovascular disease (CVD) over 20 years of follow-up. Investigators found that an estrogen dose of 0.3 mg/day was associated with a statistically significant lower risk of both major CVD and stroke, whereas higher doses were associated with an increased risk of stroke but reduced risk of CVD. (Table 2).¹⁵