Menopause Hormone Therapy in Women With Cardiovascular Risk Factors or Established Ischemic Heart Disease: A Joint FIGO and WHF Position Paper

Extending women's health-span is a key challenge for the medical community. Although women live longer than men, they face a higher burden of chronic diseases, such as cardiovascular diseases (CVDs) and disabilities. Endogenous estrogens appear to benefit cardiovascular health, and their marked decline at menopause is associated with increased cardiovascular risk; conversely, poor cardiovascular health may hasten menopause onset. Systemic menopause hormone therapy (MHT) begun early-ideally soon after symptom onset and at most within 10 years of the final menstrual period-alleviates climacteric symptoms and is associated with long-term benefits. This joint position paper between the International Federation of Gynecology and Obstetrics (FIGO) and the World Heart Federation (WHF) aims at supporting both gynecologists and cardiologists in providing a tailored and evidence-based counseling on systemic MHT use to women with increased CVD risk or established ischemic heart disease (IHD). Women with CVD risk factors require thorough risk stratification to tailor MHT type, dose, and route. For those at high thromboembolic risk, transdermal estrogen, with micronized progesterone or dydrogesterone when needed, is considered the safest regimen. Women with established IHD may receive systemic MHT for symptom relief, provided risks and benefits are carefully reviewed. Transdermal low-dose estrogen, alone or with micronized progesterone or dydrogesterone, is the best choice. All primary and secondary prevention measures, including statins, should be continued. Managing the most complex cases warrants the adoption of a multidisciplinary approach between cardiologists, gynecologists, internists and primary care providers to offer the best possible care.