International Statement on Hormone Replacement Therapy‏

A new evaluation of the evidence for Hormone Replacement Therapy (HRT) confirms that treatment needs to be tailored to the individual woman, but that most women going through the menopause need have few worries about safety. These findings are published in the peer-reviewed journal Climacteric and will be made available at the 13th World Congress on Menopause, in Rome, on 10th June (see: http://www.imsroma2011.com/)
The publication of the first Women’s Health Initiative (WHI) report in 2002 raised alarms about the safe use of HRT. However, recent and more detailed interpretations of the WHI study, plus additional work from other sources, has indicated that any risks of HRT are small, and those which exist are mostly associated with older women – not mainly those going through the menopause. Because of this recent evidence, the International Menopause Society (IMS) is updating its recommendations on the use of HRT.
-The main findings are
That a woman’s decision to take or to stay on HRT is not a simple yes or no, but needs to be agreed with her physician in the light of individual circumstances and as part of an overall health strategy.
Most women who have menopausal symptoms will benefit, and most menopausal women have little to fear from adverse effects of HRT.
Each woman is different, and her decision to take HRT will carry different benefits and risks, depending on such things as severity of symptoms, age and family history. As a woman grows older, her risks seem to increase, and so women long past the menopause should take greater care
-General Recommendations in the report
The report says that a woman’s decision to take HRT should be discussed with her physician, and should be reviewed annually. Taking HRT should be part of an overall health strategy, to include factors such as diet, exercise, stopping smoking and safe levels of alcohol consumption. Like all medicines, HRT should only be prescribed where there is a clear indication of potential benefit. A woman should use the lowest effective dose of HRT that improves her symptoms, but the decision on how long to take HRT should be discussed with her physician. Some side-effects (risks) rise as a woman gets older, so it is important that a woman continues to consult with her physician.
-Benefits
HRT is the best remedy for menopausal symptoms such as hot flushes and vaginal atrophy. These can have a severe affect on the quality of life of women going through the menopause. HRT also protects against osteoporosis and has beneficial effects on skin and joints, and there is some evidence that HRT protects against cardiovascular disease, especially in younger women (younger than 60), and colon cancer. Recent evidence from the WHI shows that in these younger women who have had a hysterectomy, estrogen therapy protects against cardiovascular disease, and has no effect on breast cancer risk.
-Risks
Women take HRT for the benefits it can give, but each woman needs to consider the potential risks, and whether they apply to her. As stated previously, the risks and benefits depend on the individual. Women who have had a hysterectomy benefit from taking HRT, in terms of reduced risk of breast cancer and cardiovascular disease.
Women taking combined HRT (estrogen and progesterone) to help them go through the menopause have slightly increased risks of breast cancer. Breast cancer is a major concern for women (although cardiovascular disease, see above, kills many more than breast cancer), and woman who are concerned, at risk, or have a family history of breast cancer, should probably not take HRT.
HRT is associated with a higher risk of stroke in women over 60. Women who wish to take HRT but who may be at increased risk of stroke might consider transdermal HRT, which does not seem to increase the risk of stroke
-On balance
On balance, HRT should be considered safe for most women going through the menopause (bear in mind that no medicine is completely safe), and the vast majority of woman who suffer from menopausal symptoms will benefit from taking HRT.
The risks associated with HRT are small, but tend to increase as a woman gets older.
A woman’s decision to take, or to stay on, HRT, should be made in consultation with her physician as part of an overall health strategy
-Dr Roger Lobo (Columbia University, New York), one of the authors of the report, said:
“This report sets out the current thinking of doctors who actually treat women going through the menopause. After the publication of the first Women’s Health Initiative report in 2002, Hormone Replacement Therapy got a very bad press, but the pendulum has been swinging back towards a greater acceptance of HRT use. Even the WHI researchers are now saying that HRT can be a good decision if the circumstances are right. This is partly because of new findings, but mainly because the original results have been better interpreted, indicating that there are few risks taking HRT during and just after the menopause – which is when it is needed most. The bottom line is that most doctors nowadays should feel comfortable about prescribing HRT to most women going through the menopause. Like all medicines, you need to look at individual circumstances before deciding to take it”.
-Co-author Professor Rod Baber (University of Sydney, Australia), commenting, said:
“This report was finalised before we saw the recent paper from the WHI which showed that HRT for women in the 50-59 age group who have had a hysterectomy is quite beneficial. For example, there was no overall increase in any adverse events or breast cancer in this group, but of course these women were able to experience the beneficial effects of HRT, including a lesser risk of cardiovascular disease and osteoporosis. There are some small risks associated with HRT use, but these risks vary from person to person and need to be kept in context. The message is, discuss HRT use with your doctor”.
-Co-author Dr David Sturdee (Solihull, UK), President of the IMS said:
“As any woman who has undergone a difficult menopause knows, the symptoms which can affect women during the menopause can really be quite undermining, and we shouldn’t undervalue the negative effect this can have on a woman or on her relationships. HRT is the best option to treat these symptoms. It is vitally important that women going through premature menopause should be given the opportunity to use HRT at least until the average age of the menopause (51y) to maintain their quality of life and to minimise long term risks such as osteoporosis, cardiovascular disease and Alzheimers. The benefits far outweigh the risks in this age group. We are not saying that HRT is right for everyone, but that every woman whose quality of life is affected should have the option to consider the benefits and risks to her of taking HRT”.