7
Treatment
Table 4. Evaluating Cardiovascular Disease (CVD) Risk in
Women Contemplating MHT
Years Since Menopause Onset
10-y CVD Risk <5 y 6 to 10 y
Low (<5%) MHT ok MHT ok
Moderate (5–10%) MHT ok (choose
transdermal)
MHT ok (choose
transdermal)
High (>10%)
a
Avoid MHT Avoid MHT
CVD risk calculated by ACC/AHA Cardiovascular Risk Calculator (Goff DC Jr, Lloyd-Jones DM,
Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the
American College of Cardiolog y/American Heart Association Task Force on Practice Guidelines.
Circulation. 2014;129:S49–S73).
Methods to calculate risk and risk stratification vary among countries.
Derived from J. E. Manson: Current recommendations: what is the clinician to do? Fertil Steril.,
with permission. © Elsevier Inc.
a
High risk includes known MI, stroke, peripheral artery disease, etc.
Table 5. Breast Cancer Risk Cutoffs for Counseling Before
Recommending MHT
a
Risk Category
a
5-y NCI or IBIS Breast
Cancer Risk Assessment, % Suggested Approach
Low <1.67 MHT ok
Intermediate 1.67–5
Caution
b
High >5 Avoid
a
Categories here are newly defined for these guidelines and based on recommendations published for
use of antiestrogens for breast cancer prevention. e assumption is that candidates for breast cancer
prevention with antiestrogens should not be candidates for initiating MHT. Method to calculate
risk varies among countries.
b
Caution indicates need for detailed counseling regarding anticipated benefits and risks of MHT
with strong consideration of nonhormonal therapies for symptom relief, and possible consideration
of chemopreventive strategies for women who meet suggested criteria.
