Menopause is a dynamic process defined by permanent loss of ovarian follicular function. It also involves extensive restructuring of complex regulatory pathways throughout the entire female body. In other words, the characteristic decline in estrogen levels in menopause extends far beyond the cessation of fertility, affecting aging trajectories of many organ systems. Moreover, this endocrine chapter is often hallmarked with disruptive symptoms. 

Estrogen is more than a reproductive hormone–it is a systemic modulator with extraordinary integrative powers. Estrogen leverages a repertoire of receptors and signaling pathways to mechanistically connect feedback loops and axes, required for survival at the cellular, tissue, organ, and ultimately whole-body levels. Disruption of estrogen homeostasis during menopause contributes to profound shifts towards metabolically compromised phenotypes in cardiovascular, musculoskeletal, genitourinary, neurological, immune, and, of course, reproductive systems. With that, menopause often presents itself with symptoms that can severely impact the quality of life of affected individuals and lead to long-term health consequences. 

Although menopause denotes cessation of reproductive function, it simultaneously elicits broader health ramifications, necessitating introduction of therapies that can address the multifaceted aspects of overall well-being affected by hormonal changes. Experts agree that systemic hormone replacement therapy (HRT) remains the most effective option for symptom management in menopause [8]. Restoration of estrogen with estrogen replacement therapy (ERT) prevents or reverses many symptoms, provides protective effects for many organs systems, and offers longevity of clinical solutions [9]. 

A thorough understanding of the benefits and risks associated with ERT is important when individualizing treatment options for menopausal patients. To this day, personalizing and optimizing HRT continues to be an unmet need in women’s health and a key issue in precision medicine. 

The goal of this white paper is to summarize published clinical evidence with regard to individualizing ERT. Types of estrogen therapies, doses, formulations, routes of administration, and duration of use will be discussed in the context of maximizing benefits and minimizing risks associated with HRT in menopause. Read the full white paper below!