This article is more than 5 years old. Information may no longer be current.
HT safe during menopause when tailored to individual patients
Click Here to Manage Email Alerts
In an updated position statement, the North American Menopause Society determined that current evidence supports the use of hormone therapy for perimenopausal and postmenopausal women as long as the benefit–risk ratio is in the patient’s favor.
The North American Menopause Society (NAMS) convened an advisory panel of clinicians and researchers in women’s health, including Margery Gass, MD, NCMP, executive director of NAMS and consultant for the Cleveland Clinic, to review the 2010 position statement, assess new evidence and come to a consensus on recommendations.
|
|
“In the decade since the first publication of results from the [Women’s Health Initiative estrogen-progestogen] study, much as been learned,” according to the statement. “There is a growing body of evidence that HT formulation, route of administration and the timing of therapy produce different effects. Constructing an individual benefit–risk profile is essential for every woman considering any HT regimen.”
Considerations for HT
Recommendations included in the position statement vary with type of therapy. Compared with combined estrogen/progestogen therapy, which has been linked to an earlier increased risk for breast cancer when used for longer than 3 to 5 years, researchers have found no apparent increase in breast cancer risk with estrogen therapy during an average of 7 years of use. Therefore, ET allows more flexibility in extending HT use, the document states. There is a lack of safety data, however, regarding use of ET in breast cancer survivors.
ET appears to be the most effective treatment for symptoms of vulvar and vaginal atrophy, although low-dose, local vaginal ET is recommended when symptoms are limited to vaginal dryness or discomfort with intercourse. The advisory panel also notes that both transdermal and low-dose oral ET have been associated with lower risks for blood clots and stroke vs. standard doses of oral estrogen, but more data from randomized trials are needed to support this conclusion.
For relief of hot flashes, EPT should be used in women with a uterus so that progestogen will protect the uterine lining from the cancer-promoting effects of estrogen alone, according to the position statement.
According to the reviewed research, neither ET nor EPT raises risk for cardiovascular disease in healthy women aged 50 to 59 years. Risk for stroke may increase, but is considered rare in this age group.
In women with premature or early menopause, HT can be used until the average age of natural menopause (51 years), and physicians can consider extending treatment duration if needed for symptom management.
Importance of individualization
Results from various studies suggest that HT is safe for women around the time of menopause for treatment of menopause-related symptoms and to prevent osteoporosis in high-risk patients. However, physicians should consider each individual woman’s health, quality of life priorities and personal risk factors for blood clots, CVD and breast cancer before initiating therapy, the document states. Furthermore, researchers must continue to investigate the use of HT in this population.
“Additional research is needed to understand the different effects of ET and EPT and how they apply to individual women,” the advisory panel wrote. “Further research is also needed to more clearly delineate the role of aging vs. menopause and the effects of genetics, lifestyle and individual clinical characteristics on midlife women’s health.”
For more information:
Disclosure: Several advisory panel and NAMS board of trustees members report financial involvement with various companies. See position statement for a list of full disclosures.
 |
Follow EndocrineToday.com on Twitter. |