which HRT to start for pre-diabetic

For a patient with pre-diabetes, hormone replacement therapy (HRT) can be considered, with preference given to transdermal rather than oral preparations to minimise cardiovascular risk.

Combined HRT is recommended for people with a uterus, while oestrogen-only HRT is appropriate for those who have had a total hysterectomy.

HRT is not associated with adverse effects on blood glucose control and can be used after considering other co-morbidities.

Use the lowest effective dose and tailor the choice of HRT to the individual's risk factors and preferences.

Regular monitoring and specialist advice may be warranted if there are additional risk factors or complications.

This approach aligns with NICE guidance on menopause management and cardiovascular risk in people with diabetes or pre-diabetes.

References: ⁴, ¹⁰