Hormone Therapy: Systemic vs Local

Systemic HRT

• Options: oral CEE, transdermal oestradiol, transdermal + oral progesterone (for women with intact uterus).
• Indications: vasomotor symptoms, sleep disruption, mood, bone protection, potentially cardiovascular protection in the timing window.
• Contraindications: history of oestrogen-sensitive breast cancer, VTE history, active liver disease.

Local vaginal oestrogen

• Options: oestradiol cream, oestradiol ring (Estring), oestradiol tablet (Vagifem).
• Indications: vaginal dryness, dyspareunia, recurrent UTIs, urgency.
• Systemic absorption is very low; systemic risks essentially absent.
• Safe in most women, including many with a history of breast cancer (individualised).

Practical framework

• Symptomatic women in the timing window: consider systemic HRT.
• GSM-only symptoms: local vaginal oestrogen is first-line.
• Contraindicated for systemic HRT: local vaginal oestrogen is usually still safe.
• Combine when both symptom sets are present.

More on this topic

• Estradiol — Biomarker.

Related entries

HRT (menopause), WHI extended follow-up, Longevity for women.