Dear Editor
I thank Johansson and colleagues for their in-depth exploration of the relationship between menopausal hormone therapy (MHT) and cardiovascular disease (CVD) risks, particularly highlighting the impact of different administration routes and formulations on CVD.[1] These findings, especially the significant differences in CVD risks between transdermal and oral administration, provide important evidence for clinical practice. However, beyond discussing treatment outcomes, we should also focus on improving patient education and promoting informed decision-making.
The choice of MHT should be a patient-centered process. From the perspective of patient education, it is essential for women to understand the cardiovascular risks associated with different administration routes. Oral MHT may be linked to an increased CVD risk, whereas transdermal administration, by bypassing the liver, has not elevated the risk of CVD and is believed to be a better option. [1] However, transdermal administration may be less convenient for some patients than oral MHT. By engaging in discussions with patients about these options and helping them understand the pros and cons of each method, we can enable them to make more informed and suitable treatment decisions.
Moreover, patient education should provide basic information about medications and formulations and involve discussions tailored to the patient’s health status and lifestyle. For example, patients with a history of cardiovascular disease or those at risk for thrombotic conditions may prefer transdermal MHT, whereas oral MHT may better suit generally healthy patients.
Helping patients understand the potential risks of MHT, especially the risk of CVD, is also an important responsibility for clinicians. In addition, I recommend developing various educational materials that specifically emphasize the benefits of transdermal administration to effectively enhance patient adherence to treatment and achieve better therapeutic outcomes.
References
1. Johansson T, Karlsson T, Bliuc D, et al. Contemporary menopausal hormone therapy and risk of cardiovascular disease: Swedish nationwide register based emulated target trial. bmj 2024;387. doi: https://doi.org/10.1136/bmj-2023-078784
Menopausal hormone therapy and risk of cardiovascular disease: Enhancing patient education and informed decision-making