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New guideline stresses benefits of HT for menopausal symptoms
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Hormone therapy is effective for most women aged up to 60 years or less than 10 years past the onset of menopause who experience bothersome hot flashes and other menopause-related symptoms, according to a clinical practice guideline released by the Endocrine Society.
The authors also note that women who are not candidates for HT or prefer not to use HT can often achieve effective relief with nonhormonal prescription therapies.
The guideline addresses a decrease in the use of HT after the publication of results of the Women’s Health Initiative study in 2002, which demonstrated that, in women aged 50 to 79 years, estrogen plus progestin increased the risk for cardiovascular complications, deep vein thrombosis and breast cancer. The data led to widespread uncertainty in patients.
Additional research has since shown that the level of risk depends upon a woman’s age, health history and other factors, said Cynthia A. Stuenkel, MD, an endocrinologist specializing in menopause at the University of California, San Diego, and chair of the guideline task force.
“We do suggest [HT] for relief of menopausal symptoms for appropriately selected patients,” Stuenkel said during a news conference discussing the guideline. “We feel that, in the years following the WHI, the baby was tossed with the bath water, and we feel that many clinicians have been hesitant to prescribe [HT]. The data that we present in our guideline helps substantiate why we think that, for carefully selected women, [HT] is a very reasonable approach.”
The guideline states that women with a uterus who decide to undergo menopausal HT with estrogen and progestogen discuss their risk for both CVD and breast cancer with their clinician. Women at a high risk for CVD or breast cancer should pursue nonhormonal therapies, whereas women with a moderate risk for CVD should consider transdermal estradiol-progestogen (or estradiol alone for women without a uterus).
“Women can get effective relief [for] their vasomotor symptoms with nonhormonal prescription therapies,” Stuenkel said. “We’ve learned so much from studies initially done in women with breast cancer who are proscribed from using [HT]. Drugs in the category of antidepressants, the [serotonin reuptake inhibitors], the [serotonin-norepinephrine reuptake inhibitors], drugs like gabapentin and pregabalin can be very effective. [They’re] not quite as effective as estrogen, but very effective [for] at least improving the tolerance of vasomotor symptoms.”
Health care professionals should individualize therapy based on clinical factors and the woman’s preference, Stuenkel said, while noting that for most symptomatic, postmenopausal women younger than 60 years, the benefits of HT can outweigh any risks.
“We, as endocrinologists, have been a little bit dismayed, if you will, to see the incredible drop off in the use of [HT],” Stuenkel said during the news conference. “It is admittedly a complicated arena, and I don’t blame the average clinician for being either confused or frustrated by some of the conflicting, contradictory and complicated data that has emerged in the last decade or so. What we wanted to do was take a strong stance, try to simplify this data, and say that, while admittedly, [HT] is not for everyone ... in carefully selected women, it is OK to use and will be the most effective therapy that we have.”
The guideline also encourages clinicians to talk to menopausal patients about vaginal and urinary symptoms, which remain largely untreated. Local, low-dose vaginal estrogen therapy and systemic selective estrogen receptor modulator therapy can be effective in treating most genitourinary symptoms, Stuenkel said.
The guideline, available online, will also be published in The Journal of Clinical Endocrinology & Metabolism in November. – by Regina Schaffer
Disclosure: Stuenkel reports no relevant financial disclosures. Please see the guideline for the other authors’ relevant financial disclosures.
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