According to the North American Menopause Society, hormone replacement therapy (HRT) with low-dose oral or transdermal estrogen and cyclic monthly progesterone started soon after the start of menopause improves depression, anxiety, and cognitive function of healthy women.

Study results from the Kronos Early Estrogen Prevention Study (KEEPS) showed that HRT shows this benefit without posing any cardiovascular disease risk. This 4-year, randomized, double-blind, placebo-controlled study evaluated 729 healthy women aged 42–58 who were within 3 years after menopause at the time of randomization. Patients were randomized to the following groups:  Premarin (conjugated equine estrogen tablets; Pfizer) 0.45mg/day, Climara (estradiol transdermal patch; Bayer HealthCare) 50mcg/day, and placebo. All patients received Prometrium (progesterone [micronized]; Abbott). Researchers also assessed carotid artery intima media thickness (CIMT) and coronary artery calcium (CAC) to evaluate cardiovascular harm.

Researchers were able to conclude that neither type of estrogen replacement therapy used significantly affected systolic or diastolic blood pressure, in contrast to the higher dose of oral conjugated equine estrogens (CEE) that were used in Women’s Health Initiative trial. In addition, the oral conjugated equine estrogen, but not the patch, was associated with an increase in HDL cholesterol and triglyceride levels. Transdermal estrogen also showed improved insulin sensitivity as calculated from HOMA-IR (homeostasis model assessment of insulin resistance).

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