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Efficacy, Safety, and Tolerability of Low-Dose Hormone Therapy in Managing Menopausal Symptoms
Journal of the American Board of Family Medicine, 09/08/09

Langer RD et al. – Current guidelines recommend that HT should be used at the lowest effective dose consistent with the treatment goals of the individual. Observational data suggest that the use of lower HT doses is not associated with a significant increase in risk of major adverse events; however, there are minimal data from clinical trials on the long–term safety of these preparations. Large, randomized, controlled trials evaluating the long–term efficacy and safety of low–dose HT are urgently needed. In keeping with the general clinical precept of using the lowest effective dose, lower–dose HT formulations should be considered for the initial management of menopausal symptoms. Patients newly initiated on HT should be encouraged to promptly communicate symptoms and concerns. Dosage or regimen changes should be considered if treatment goals are not met after a suitable interval, typically 1 to 3 months. The use of lower HT doses is supported by evidence demonstrating that they effectively relieve vasomotor symptoms, treat vaginal atrophy, prevent bone loss, provide adequate endometrial protection, and are better tolerated than standard doses.