Medical Groups Agree on Use of Hormone-Replacement Therapy

MONDAY July 9, 2012 -- A coalition of leading medical groups has concluded that hormone-replacement therapy can be useful and safe for many women suffering from the symptoms of menopause.

The coalition includes 15 medical groups, including the North American Menopause Society, the American Society for Reproductive Medicine, the Endocrine Society and the American Academy of Family Physicians.

The goal of the statement, released Monday, is to reassure women and doctors that hormone-replacement therapy (HRT) is acceptable and relatively safe for healthy, symptomatic, recently postmenopausal women, the statement authors said in a news release.

"Over the last 10 years, there has been a complete abandonment of hormone therapy in some settings accompanied by reluctance to treat women who would benefit from relief of their [menopausal] symptoms. As a result, some women have sought unproven alternative therapies," the authors added.

The use of hormone-replacement therapy has been steeped in controversy since 2002 when the Women's Health Initiative study said it was too risky to use, linking the therapy to increased risks of breast cancer and heart disease.

"We want to emphasize the difference between taking hormone therapy short-term for treatment of menopausal symptoms versus taking hormone therapy for prevention of chronic diseases. Many women can safely take hormone therapy for relief of menopausal symptoms when they work closely with their provider to assess their personal risks and benefits," Dr. Margery Gass, executive director of the North American Menopause Society, said in the news release. "Women and clinicians have been frustrated by the many conflicting recommendations over the past 10 years. This statement should be reassuring to all."

Highlights of Monday's statement include:

  • Hormone therapy is an acceptable choice for the relatively young (up to age 59 or within 10 years of menopause) and healthy women who are bothered by moderate-to-severe menopausal symptoms.
  • The decision to use HRT should be decided on a case-by-case basis.
  • Low-dose estrogen alone is recommended for women with only vaginal dryness or discomfort during intercourse.
  • Progesterone and estrogen are recommended for women who still have a uterus to prevent uterine cancer. Estrogen alone is sufficient for women without a uterus.
  • HRT increases the risk for blood clots in the legs and lungs; this risk is rare in women 50 to 59 years old.
  • Breast cancer risk increases when HRT is taken continuously for five years -- and possibly earlier. The risk declines when HRT is stopped.

The statement was published in the journals of The North American Menopause Society, the American Society for Reproductive Medicine, and The Endocrine Society. It has been endorsed by the Academy of Women's Health, the American Academy of Family Physicians, the American Academy of Physician Assistants, the American Association of Clinical Endocrinologists, the American Medical Women's Association, the Association of Reproductive Health Professionals, the National Association of Nurse Practitioners in Women's Health, the National Osteoporosis Foundation, the Society for the Study of Reproduction, the Society of Obstetricians & Gynaecologists of Canada, the SIGMA Canadian Menopause Society, and the Asociacion Mexicana para el Estudio del Climaterio.

Dr. Elizabeth Poynor, a gynecologic oncologist and pelvic surgeon at Lenox Hill Hospital in New York City, who was not involved with the statement, said that "the statement hasn't necessarily clarified the situation, but I think it's going to help some physicians who have been reluctant to prescribe HRT based in the Women's Health Initiative study, which we all know was a flawed study."

The new statement "may provide some reassurance that it is the appropriate thing to do for some women," she added.

The Women's Health Initiative was flawed because it was done with women who had no menopausal symptoms and were well past menopause, Poynor said.

"The study didn't look at women who are considering HRT for symptomatic relief," she said.

Women who are suffering from menopausal symptoms such as hot flashes and mood swings should consult their doctor about HRT, and whether it is a good choice for them, Poynor said.

"It [the new statement] provides us some comfort as physicians, and comfort to women, that this is not necessarily a bad thing to do, it can be a helpful thing to do," she said.

Women who are on HRT should regularly reassess whether or not they need to continue it, Poynor added. "Begin to taper off if you don't need it," she said.

More information

For more on HRT, visit the U.S. National Library of Medicine.

Posted: July 2012


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