July 11, 2017
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AACE/ACE guideline: HT should be individualized in menopause treatment

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The decision to initiate hormone therapy in symptomatic, postmenopausal women should be based on a woman’s individual risk factors for cardiovascular disease, age and time from menopause, in addition to other factors, according to an updated position statement issued by the American Association of Clinical Endocrinologists and the American College of Endocrinology.

The Position Statement on Menopause — 2017 Update revises the previous menopause clinical practice guideline published in 2011. The update incorporates reviews from more-recent clinical trials, including findings from the KEEPs trial, ELITE trial and the Danish Osteoporosis Prevention Study, as well as new information on nonhormonal treatments, including the use of selective serotonin reuptake inhibitors (SSRIs) and the anticonvulsant gabapentin.

The updated guideline also addresses new warnings from the FDA regarding the use of bioidentical HT, which reinforce previous recommendations regarding this treatment from AACE.

“AACE feels it is important to emphasize that one size doesn’t fit all when it comes to treating women with menopause,” Rhoda H. Cobin, MD, FACE, clinical professor of medicine at Mount Sinai School of Medicine in New York, past president of AACE and a member of its Reproductive Endocrinology Scientific Committee, said in a press release. “Hormone replacement therapy must be individualized based on a woman’s age, time of onset of menopause and other [CV], metabolic and genetic factors.”

“These new recommendations to AACE’s menopause clinical guidelines are the latest examples of AACE taking the lead in improving and setting the expectations for high-quality standards of care for our patients,” Jonathan D. Leffert, MD, FACP, FACE, ECNU, president of AACE and an Endocrine Today Editorial Board Member, said in the release.

The statement outlines seven new positions in addition to individualizing HT for each woman:

  • The use of transdermal estrogen therapy may be less likely to confer thrombotic risk and, perhaps, the risk for stroke and coronary heart disease vs. oral estrogen preparations.
  • When progesterone is necessary, micronized progesterone is considered the safer alternative.
  • In women with menopausal symptoms who are at significant risk from the use of HT, the use of SSRIs and possibly other nonhormonal agents may offer significant symptom relief.
  • AACE does not recommend the use of bioidentical HT.
  • AACE confirms that certain SSRIs are contraindicated in patients with breast cancer assigned tamoxifen.
  • HT is not recommended for the prevention of diabetes.
  • In women diagnosed with diabetes, the use of HT should be individualized, considering age, metabolic and CV risks.

“The updated position statement on menopause demonstrates AACE’s commitment to individualizing our guidelines as much as current science permits for the betterment of patient care,” R. Mack Harrell, MD, FACP, FACE, ECNU, president of the American College of Endocrinology (ACE), said in the release.

The updated guideline is published in the July issue of Endocrine Practice.by Regina Schaffer

Disclosures: Cobin and Goodman report no relevant financial disclosures.