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.
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Margery Gass
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“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.