HT: Pharmacology Tailored to Women’s Health

Abstract

Menopausal hormonal therapy (HT) has a multifaceted balance of benefits and risks. Contemporary findings from the Women’s Health Initiative (WHI) and other studies suggest that a woman’s clinical and biological characteristics may modify her health outcomes of HT and demonstrate a significant variability in the HT doses required for symptom relief. Thus, it may be possible to tailor pharmacology, i.e., the optimal dose, formulation, and route of delivery of treatment. For women experiencing primary ovarian insufficiency (POI) or early menopause, estrogen administration is needed not only for symptom management but also protection against the potential long-term adverse health consequences. While the doses of estradiol required for bone protection have been reckoned, the ideal dose for optimizing serum or tissue levels needed for brain and heart protection in women with POI or early menopause is yet to be determined. Several individual characteristics have been proposed for this purpose including baseline clinical vascular health, risk for breast cancer, biomarker levels, and genetic predisposition. Pharmacogenomics is an important part of such personalized approach. The goal of pharmacogenomics is selecting the right formulation in order to ensure drug efficacy and to avoid adverse drug reactions. The current presentation reviews the evidence of tailoring HT use, based upon personalized risk-benefit prediction in CVD.