HRT-Calc | Menopausal Hormone Therapy Decision Aid

Intake

Risk Profile

Recommendation

Formulary

Guidelines

👤 Patient Demographics

Core clinical identifiers and menopausal staging

Age & Menopausal Timing

Current Age years

Age at Menopause years

LMP Date (if applicable)

Menopausal Classification

Menopausal Status

Perimenopausal

Postmenopausal

Surgical/oophorectomy

POI (<40)

Early meno (40–45)

Unsure

Uterine Status

Intact uterus

Total hysterectomy

Subtotal/supracervical

Current Menstrual Activity Drives contraception & progestogen regimen logic

Still menstruating (regular)

Menstruating (irregular / skipping cycles)

Spotting only

Amenorrhea <12 months

Amenorrhea ≥12 months

Post-hysterectomy / no uterus

Bleeding Pattern Concerns

Normal for stage

Heavy/prolonged (HMB)

Intermenstrual bleeding

Postcoital bleeding

Post-menopausal bleeding

⚠️ Heavy, intermenstrual, or postmenopausal bleeding requires TVUS ± endometrial biopsy before initiating HRT

Perimenopause Onset Age if known

BMI kg/m²

🎯 Indications & Symptoms

Select all active clinical indications for HRT consideration

Hormonal Indications

Vasomotor symptoms (hot flashes / night sweats) FDA-approved Genitourinary syndrome of menopause (GSM) FDA-approved Osteoporosis prevention / low bone density FDA-approved Hormone replacement in POI / premature menopause essential Mood instability / perimenopausal depression Sleep disturbance / insomnia (menopause-related) Hypoactive sexual desire disorder (HSDD) Joint pain / musculoskeletal symptoms

Symptom Severity

VMS Severity

None

Mild

Moderate

Severe / debilitating

VMS Frequency

0–2/day

3–6/day

7–12/day

≥13/day

Contraception Still Needed?

Yes

Unsure

Prior HRT Use

Never used

Currently on HRT

Prior HRT (stopped)

🧪 Laboratory Values (optional)

Not required for a recommendation — add if available. Abnormal values will flag clinical guidance.

▸ Show labs & bone health imaging

Hormonal Markers

FSH mIU/mL

Estradiol (E2) pg/mL

TSH mIU/L

Total Testosterone ng/dL

Metabolic Panel

Total Cholesterol mg/dL

LDL mg/dL

HDL mg/dL

Triglycerides mg/dL

Fasting Glucose mg/dL

HbA1c %

AST U/L

ALT U/L

Hematologic / Renal

Hemoglobin g/dL

Platelets K/µL

Creatinine mg/dL

Vitamin D ng/mL

Bone Health Imaging

DEXA T-score lowest site

FRAX 10-yr Hip Fx %

Bone Health Status

Normal

Osteopenia

Osteoporosis

Mammography Status

Current (normal)

Current (abnormal/pending)

Not current

⚠️ Contraindication Screening

Absolute contraindications preclude systemic HRT; relative require route modification

Absolute Contraindications

Personal history of breast cancer ABS Active / untreated endometrial cancer ABS Unexplained vaginal bleeding ABS Active VTE (DVT / PE) ABS Active / recent MI, stroke, or TIA ABS Active liver disease ABS Known CHD or peripheral artery disease ABS Known or suspected pregnancy ABS Active estrogen-sensitive ovarian cancer ABS

Relative Contraindications

Prior VTE (resolved) REL Thrombophilia (Factor V Leiden, antiphospholipid, etc.) REL Hypertriglyceridemia (>400 mg/dL) REL Active / recurrent gallbladder disease REL Migraine with aura REL Uncontrolled hypertension (≥180/110) REL BMI ≥35 REL History of endometriosis REL SLE or antiphospholipid syndrome REL Strong family history of breast cancer (1st-degree) REL

🩺 Breast Cancer Risk Profile

WHI, ESTHER, CGHFBC data · FDA 2026: boxed warning removed for breast cancer

Personal History

Personal Breast Cancer History or Breast Biopsy

Yes

Personal Breast Cancer — Type

Yes — ER+ / PR+

Yes — ER− / triple-neg

Yes — DCIS

Breast Biopsy History

Atypical hyperplasia

LCIS

DCIS (treated)

Breast Density (BI-RADS)

A: Fatty

B: Scattered

C: Heterogeneous

D: Extremely dense

Hereditary & Family Risk

Family History Breast Ca

Yes

Family History Breast Ca — Detail

1 first-degree relative

≥2 first-degree relatives

2nd-degree only

BRCA / Genetic Testing

Not tested

Tested — negative

BRCA1 positive

BRCA2 positive

Other pathogenic variant

Tyrer-Cuzick / Lifetime Risk

<15% (average)

15–20% (intermediate)

>20% (high)

Not calculated

❤️ Cardiovascular & VTE Risk

ACC/AHA ASCVD 2023 · ESTHER trial · WHI re-analysis 2025

ASCVD Risk Factors

Hypertension (controlled) Hypertension (uncontrolled ≥150/95) Diabetes mellitus (type 1 or 2) Dyslipidemia / hypercholesterolemia Active cigarette smoking Obesity (BMI ≥30) Family hx premature CVD (1st-degree <55 M / <65 F) Chronic kidney disease (eGFR <60) Rheumatoid arthritis / inflammatory disease

Blood Pressure mmHg

ASCVD Risk Score & VTE

10-Year ASCVD Risk (Pooled Cohort)

Unknown

<5% (low)

5–7.5% (borderline)

7.5–20% (intermediate)

>20% (high)

VTE Risk Factors

Prior personal VTE episode (DVT or PE) Family history VTE (1st-degree) Factor V Leiden or other thrombophilia BMI ≥35 kg/m² Immobility / recent surgery / long-haul travel Antiphospholipid syndrome / SLE

🦴 Additional Clinical Context

Bone, cognitive, metabolic, and psychosocial factors

Cognitive & Neurological

Subjective cognitive complaints (perimenopausal brain fog) Family history of Alzheimer's / dementia Mild cognitive impairment (diagnosed) History of depression or anxiety

Smoking Status

Never

Former

Current

Metabolic & Other

Prediabetes / insulin resistance NAFLD / NASH / hepatic steatosis History of PCOS History of preeclampsia / gestational HTN Early CVD risk factors in pregnancy

Overall HRT Candidacy Assessment (clinical gestalt)

Good candidate

Candidate with modification

Marginal candidacy

Non-candidate

ℹ️

Complete Patient Intake (Step 1) and Risk Assessment (Step 2), then click Generate Full Recommendation to view the clinical decision summary.

💊 HRT Formulary Reference

Approved formulations, routes, VTE/breast cancer risk signal, and efficacy — FDA 2026

📖 Clinical Guideline Summary

Contraindications, evidence by outcome domain, and guideline statements