Towards an individualised, evidence-based approach to menopausal hormone treatment

Menopausal hormone therapy (MHT) is used to treat delibitating menopausal symptoms, which affect 70% of women, compromising their quality of life.

In the 1990s, MHT was widely prescribed with extensive benefits, not only improved wellbeing but also cardiovascular protection. This trend was suddenly broken by reports of fatal side-effects. MHT use plummeted, triggering a shift towards fearful attitudes of women and prescribers. Despite severe limitations in these studies and lack of subsequent evidence, MHT use never reached earlier levels.

Thus, many women in need of effective and safe treatment suffer in silence. In parallel, new MHT formulations have now been in use for years.

Sizeable epidemiological studies show promise but well-designed studies in a Swedish context are needed to contribute evidence to one of the biggest knowledge gaps in modern gynecology; enabling clinicians and women to make informed, individualized decisions.

To this end, this mixed-method project aims to address this gap, conducting: (1) two national studies on attitudes and preferences in perimenopausal women and prescription attitudes among clinicians, (2) register-based studies examining the effects of different MHT regimens on health outcomes and (3) a multi-center double-blind randomized controlled trial on the effects of micronized progesterone vs. medroxyprogesterone acetate, in combination with transdermal estradiol, on endometrial and breast cancer, relevant metabolic markers and mood.