Chart — Maternal-Newborn
Menopausal Hormone Therapy Comparison Chart
The one rule that drives the whole chart: a woman with a uterus needs progestin added to estrogen, because unopposed estrogen causes endometrial cancer. Beyond that, match the option to the symptom and the contraindications.
Educational use only. Hormone therapy is individualized (symptoms, age, time since menopause, and risk). Decisions are provider-directed; this chart is educational. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Options Side by Side
| Option | Who it’s for | Treats | Key point |
|---|---|---|---|
| Estrogen-only (systemic) | Women WITHOUT a uterus (post-hysterectomy) | Moderate–severe hot flashes/night sweats; GSM | Unopposed estrogen is safe only without a uterus |
| Estrogen + progestin (systemic) | Women WITH a uterus | Moderate–severe vasomotor symptoms; GSM | Progestin protects the endometrium (prevents hyperplasia/cancer from unopposed estrogen) |
| Low-dose vaginal estrogen | Women with genitourinary symptoms only | Vaginal dryness, dyspareunia, urinary symptoms (GSM) | Minimal systemic absorption; preferred when GSM is the main issue |
| Non-hormonal Rx (SSRIs/SNRIs, gabapentin) | When hormone therapy is contraindicated/declined | Vasomotor symptoms (less effective than HT) | Useful for clot/cancer-history patients who can't take estrogen |
| Lifestyle measures | All patients (first-line/adjunct) | Mild symptoms; supports bone/heart health | Layered clothing, cool environment, trigger avoidance, exercise, calcium/vit D |
Contraindications to Systemic Estrogen
- ✕History of breast or other estrogen-dependent cancer
- ✕History of VTE / stroke / coronary heart disease
- ✕Active or recent thromboembolic disease
- ✕Unexplained vaginal bleeding (evaluate first)
- ✕Active liver disease
- ✕Known or suspected pregnancy
Exam Traps
- ✦Uterus present → estrogen + progestin; no uterus → estrogen alone. Unopposed estrogen with a uterus = endometrial cancer risk.
- ✦Low-dose vaginal estrogen treats GSM with minimal systemic absorption — the go-to when dryness/dyspareunia is the main complaint.
- ✦Clot, stroke, CHD, or estrogen-dependent cancer history = systemic estrogen contraindicated → use non-hormonal options.
- ✦Evaluate unexplained/postmenopausal bleeding BEFORE starting hormone therapy.
- ✦Lifestyle measures and bone/heart protection apply to everyone, regardless of hormone therapy.
Related Resources
Standards & sources
Fact-checked Jun 20, 2026This page is written to align with American College of Obstetricians and Gynecologists (ACOG) · AWHONN · American Academy of Pediatrics (AAP) — newborn. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →