Hormone therapy is the most effective treatment for menopause-related symptoms. Current evidence supports its use in young healthy postmenopausal women under the age of 60 years, and within 10 years of menopause, with benefits typically outweighing risks. However, decision making is more complex in the more common clinical scenario of a symptomatic woman with one or more chronic medical conditions that potentially alter the risk-benefit balance of hormone therapy use. In this review, we present the evidence relating to the use of hormone therapy in women with chronic medical conditions such as obesity, hypertension, dyslipidemia, diabetes, venous thromboembolism, and autoimmune diseases. We discuss the differences between oral and transdermal routes of administration of estrogen and the situations when one route might be preferred over another. We also review evidence regarding the effect of different progestogens, when available.

激素疗法是治疗更年期相关症状最有效的方法。目前的证据支持将其用于 60 岁以下和绝经后 10 年内的年轻健康绝经后妇女，其益处通常大于风险。然而，在更常见的临床情况下，决策制定更为复杂，即有症状的女性患有一种或多种慢性疾病，可能会改变激素治疗使用的风险收益平衡。在这篇综述中，我们提出了在患有肥胖、高血压、血脂异常、糖尿病、静脉血栓栓塞和自身免疫性疾病等慢性疾病的女性中使用激素疗法的相关证据。我们讨论了雌激素口服给药途径和经皮给药途径之间的差异，以及一种途径可能优于另一种途径的情况。