Endocrine Society scientific statement outlines benefits, risks of menopausal HT

The Endocrine Society 92nd Annual Meeting

SAN DIEGO — A scientific statement on menopausal hormone therapy designed to provide a comprehensive, objective evaluation of the benefits and risks of therapy was released in conjunction with The Endocrine Society’s annual meeting.

The statement was created in response to new information from the Women’s Health Initiative (WHI), which suggested that women who started HT shortly after the onset of menopause, around age 50 to 59 years, respond differently to treatment than women who start HT after age 60 years.

“The risks and benefits of HT in women differ, depending on when therapy is initiated,” Richard J. Santen, MD, professor of medicine in the department of internal medicine at University of Virginia School of Medicine, said during a press conference.

Santen said women in the WHI who started HT shortly after reaching menopause had a 30% to 40% reduction in mortality, no increased risk for cardiovascular disease and a 90% reduction in menopausal symptoms.

The scientific statement includes primary areas of benefit from HT, including relief from hot flushes and urogenital atrophy and prevention of fractures and diabetes.

Risks included venothrombotic episodes, stroke and cholesystitis. Concerning the risk for breast cancer, estrogen plus progestin was related to growth of existing tumors rather than de novo tumors. In the subgroup of women who started HT within 10 years of starting menopause, estrogen plus progestogens increased the risk for breast cancer, whereas estrogen did not. HT was not found to be associated with CVD, colorectal cancer, endometrial cancer or lung cancer.

“We believe that the scientific statement suggests, and will lead to, a change in perspective for women in the 55 to 60 age range. Therapy needs to be individualized, based on symptoms and underlying risks of breast cancer and heart disease,” Santen said. “This shift in thinking needs to consider the risks and benefits for the women who are actually considering menopausal HT use.” – by Matthew Brannon

There are many suggestions out right now for relieving menopausal symptoms, and absolutely none of them are FDA approved. Of all the publicity that new agents get, only estrogen is FDA approved. Hopefully other agents such as progesterone will get this approval once other studies are complete, but we really have a long way to go to have some improved treatments for menopausal women.

– Nanette Santoro, MD

Professor and E. Stewart Chair of Obstetrics and Gynecology,
University of Colorado at Denver School of Medicine

For more information:

Santen RJ. J Clin Endocrinol Metab. 2010;95:S1-S66.