Hormone replacement therapy in menopause: metabolic impacts beyond the management of vasomotor symptoms

Abstract

Menopause is a natural physiological event characterized by the definitive cessation of menstruation, resulting from the decline of ovarian function and the consequent reduction in estrogen and progesterone production. This period is often accompanied by clinical manifestations that significantly impact the quality of life of women, including vasomotor symptoms, mood changes, sleep disturbances, and metabolic alterations that may increase the risk of cardiovascular diseases and osteoporosis. Hormone Replacement Therapy (HRT) has been widely studied as a strategy to mitigate menopause symptoms and prevent associated metabolic complications. However, the indication of this treatment must be careful, considering the risks and benefits for each patient. Studies show that HRT can improve body composition, reduce insulin resistance, and modulate inflammatory processes, contributing to a more favorable metabolic profile. Research also investigates the impact of the administration route on HRT efficacy and safety, with transdermal therapy being associated with a lower risk of thromboembolic events compared to oral administration. Despite its benefits, HRT is not without risks, such as an increased incidence of hormone-dependent neoplasms and adverse cardiovascular events. Therefore, individualized evaluation is crucial to ensure the safety and efficacy of treatment. This study aims to analyze the metabolic impacts of HRT in menopause, focusing on its benefits and possible risks in different clinical contexts.