Clinicians ‘should be open’ to menopausal hormone therapy beyond age 65 years
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Key takeaways:
- The most common reasons cited for continuing menopausal hormone therapy were hot flashes, chronic pain, arthritis symptoms and quality of life.
- More than half of women continued HT due to ongoing symptoms.
CHICAGO — Hormone therapy is beneficial for some women beyond age 65 years to treat ongoing menopausal symptoms that affect their quality of life, according to research reported at the Annual Meeting of The Menopause Society.
“Globally, women are living longer and healthier lives. Many women over age 65 years still experience debilitating menopausal symptoms, impacting their quality of life, and thus rely on menopausal HT,” Meenakshi Goel, MBBS, MRCOG, fellow in the Menopause program in the department of gynecology at Mount Sinai Hospital, and Wendy Wolfman, MD, FRCS(C), FACOG, MSCP, professor in the department of obstetrics and gynecology at the University of Toronto and director of the Menopause and Premature Ovarian Insufficiency Units at Mount Sinai Hospital, told Healio. “Health practitioners should be open to considering the continuation of menopausal HT for this age group after evaluating their current health status and personal and family history, particularly focusing on gynecological cancers and cardiovascular health. Informed decision-making, thorough counselling, and regular monitoring for adverse effects and contraindications are crucial.”
Goel and Wolfman conducted a retrospective chart review of 110 women aged 65 years or older (mean age, 71 years) currently using menopausal HT. Researchers obtained data on demographics, type of HT and years since menopausal HT use, indications for continuation, frequency of adverse events and any major or minor adverse events caused by menopausal HT.
Mean age of menopause onset was 50 years and mean age at menopausal HT initiation was 52 years. Women used menopausal HT for an average of 18 years; 42% had continued use for 20 years or more. Nearly 88% of women used a transdermal estrogen formulation; 12% used oral estrogen pills and less than 5% used synthetic progestins.
Vasomotor symptoms (80%), genitourinary symptoms of menopause (57%), mood swings (39%), sleep disturbances (68%) and sexual symptoms (54.5%) were the most commonly reported reasons for initiation and continuation of menopausal HT.
The most common reasons for menopause HT continuation beyond age 65 years were:
- to control vasomotor symptoms (55%);
- better quality of life (29%); and
- reduction in chronic pain and arthritis symptoms (7%).
Nearly two-thirds of women never attempted menopause HT cessation due to ongoing symptoms or better quality of life during use. However, 26.4% of women attempted menopausal HT cessation once and 8.2% attempted cessation two or more times. Among women who stopped menopausal HT once, 87% reported vasomotor symptom recurrence, which resulted in restarting menopausal HT.
The most common adverse event caused by menopausal HT was postmenopausal bleeding (36.6%). Two women had ductal carcinoma in situ breast cancer while using menopausal HT. These women temporarily discontinued HT and restarted 10 years after surgery if disease-free and after consulting with an oncologist. One woman developed deep vein thrombosis while taking an oral formulation of menopausal HT and was switched to the lowest dose of transdermal estrogen while on anticoagulants after consulting with a hematologist.
Researchers did not report any incidence of stroke, myocardial infarction or uterine cancer.
“The clinical implications of the findings suggest that continuing menopausal HT should be carefully considered for women over age 65 years, taking into account their individual health and medical history. However, this age cut-off should not be the only determinant for discontinuation of menopausal HT,” Goel and Wolfman told Healio. “Moving forward, further research into the long-term effects and benefits of menopausal HT for women over age 65 years is needed. It is unlikely that a prospective randomized trial will ever be conducted to answer this question. Therefore, we have to rely on large population and database studies to guide us.”
For more information:
Meenakshi Goel, MBBS, MRCOG, can be reached at meenugoel1988@gmail.com.