Over the span of the past two decades, menopausal medications have undergone extensive changes. The perception of passive substitution of hormone-sapped state has been replaced eventually by supervised therapy of symptomatic women.

HRT or Hormone Replacement Therapy is effectual in providing symptomatic respite from bothersome menopausal symptoms and its employment for this purpose is wholly validated when the symptoms have an adverse effect on day-to-day functioning.

HRT comprises of administering either a plain estrogen (conjugated estrogen) preparation or a combination of estrogen and progesterone (combo of conjugated estrogen + medroxyprogesterone acetate) advised either on acyclic or continual basis. Alongside HRT treatment, women must be adequately counselled about adhering to proper dietary intake and healthier lifestyle choices.

Ideally, doctors advocate giving lowest effectual dosage for menopausal women that should be used for the shortest duration necessary and the reappraisal of the treatment undertaken at least on a yearly basis. ‘Short interval’ HRT could be considered for close to 5 years and is normally targeted for allaying menopausal symptoms amongst women lying in their early fifties.

If there is a relapse of the menopausal symptoms after halting the hormones, an informed conclusion could be derived to recommence the treatment. The total risk-benefit balance for HRT in women not having menopausal symptoms is not normally favourable. When deemed appropriate, women are guided by the concerned doctor in terms of the absolute risks of the identified unfavourable and useful effects of HRT, instead of the relative risks.

Ideally, well-balanced data regarding HRT must be readily accessible to both clinicians and the mass public, so that symptomatic menopausal women who choose to undergo HRT must be backed by clued-in healthcare professionals.

HRT can additionally be employed on younger women (lesser than 40 years) that experience an untimely menopause, unless contraindicated, for treatment of menopausal symptoms and averting osteoporosis till the age of normally occurring menopause, when the therapy would need a reviewal.

HRT could additionally be employed as an ‘add-back therapy’ when GnRH or Gonadotropin-releasing hormone agonists are given to avert menopausal symptoms. Women that have undergone a surgical menopause due to bilateral oophorectomy could gain from testosterone replacement in addition to oestrogen particularly for improving libido.

Topical or local application of oestrogen replacement or conjugated oestrogen cream might be needed on a long-standing basis for reversing the symptoms of urogenital atrophy that is a late symptom of oestrogen deficiency. It emerges as a more effectual treatment than systemic therapy in this regard.

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