This first-line protocol applies to menopausal women with moderate to severe hot flashes who have an intact uterus and no contraindication to estrogen therapy. The presence of the uterus is the defining factor that shapes the hormonal treatment strategy.
The patient experiences moderate to severe hot flashes — the hallmark vasomotor symptoms of menopause — with an intact uterus. No contraindication to estrogen therapy is present. This combination determines that endometrial safety must be addressed alongside symptom management.
The primary objective is meaningful reduction of vasomotor symptoms — hot flashes and night sweats. Menopausal hormone therapy, appropriately configured for women with an intact uterus, is the current standard approach to reach this goal.
For women with an intact uterus, the protocol involves combined hormone therapy — systemic estrogen together with a component that provides endometrial protection. A tissue-selective estrogen complex represents an alternative formulation pathway. The full regimen details, agent selection, and scheduling are available in the complete protocol.
Moderate to severe hot flashes: MHT is the gold standard and best therapy for reduction of VMS, followed by non-hormonal prescription medications as a second choice.
Women with a uterus can use either systemic estrogen combined with a progestogen (EPT) or the tissue-selective estrogen complex (conjugated equine estrogens and bazedoxifene).
In women with a uterus, the proliferative effects of systemic estrogen on the endometrium must be countered by an appropriate dose of progestogen (or a SERM, in the case of the TSEC).
Menopausal hormone therapy (systemic estrogen alone, or with appropriate endometrial protection in women with a uterus) is the current standard therapy for reduction of VMS.
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