Medical Groups Agree on Use of Hormone-Replacement Therapy

MONDAY, July 9 (HealthDay News) — 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.

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