A decade of debate over the risks and benefits of hormone replacement therapy has prompted 15 leading medical organizations to issue new guidelines recommending HRT as a safe and beneficial option for symptomatic menopausal women, while also clarifying which patients are most – and least – suitable for treatment
The guidelines come exactly 10 years after the controversial, highly publicized Women's Health Initiative study concluded the risks of HRT outweighed the benefits for the prevention of chronic disease. The new joint statement – prepared by The North American Menopause Society, the American Society for Reproductive Medicine, and The Endocrine Society – concludes HRT is still an acceptable treatment for menopausal symptoms. This statement was endorsed by 12 other leading organizations in women's health.
"We believe that too many symptomatic women are missing out on the proven benefits of [HRT] because the results of the WHI, which studied the long-term use of hormones to prevent chronic disease, were misinterpreted for women with menopausal symptoms," said Dr. Margery Gass, executive director for NAMS. "Women and clinicians are frustrated by the many conflicting recommendations. That's why we initiated this effort to bring these notable medical organizations together in agreement regarding the use of hormone therapy."
She said the purpose of this statement is to reassure women and their providers that HRT is acceptable and relatively safe for healthy, symptomatic, recently postmenopausal women. Over the last 10 years, many doctors have been reluctant to treat women with HRT and, as a result, some have sought unproven alternative therapies.
Dr. Roger Lobo said patients should work with their doctors to determine if they are good candidates for HRT, based on their symptoms, medical history and other factors.
Among the new guidelines’ major points:
• HRT is an acceptable option 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.
• Women who still have a uterus need to take a progestogen (progesterone or a similar product) along with the estrogen to prevent cancer of the uterus. Women who have had their uterus removed can take estrogen alone.
• Both estrogen therapy and estrogen with progestogen therapy increase the risk of blood clots in the legs and lungs, similar to birth control pills, patches, and rings. Although the risks of blood clots and stroke increase with either type of hormone therapy, the risk is rare in women ages 50-59.
• An increased risk in breast cancer is seen with 5 or more years of continuous estrogen with progestogen therapy, possibly earlier. The risk decreases after hormone therapy is stopped.
The full statement can be found at www.menopause.org.