Experts Say Hormone Replacement Generally Safe in Short-Term

But treatment should be customized for each woman, new guidelines say

By Kathleen Doheny
HealthDay Reporter

THURSDAY, June 9 (HealthDay News) -- Treatment with hormone replacement therapy (HRT), if tailored to an individual woman's needs, appears to be safe during menopause, according to a report scheduled for release Friday at the World Congress on Menopause in Rome, Italy.

"The evidence is quite compelling that young, healthy women do quite well and benefit in several ways," said Dr. Roger Lobo, professor of obstetrics and gynecology at Columbia University in New York City, a member of the working group that updated the HRT guidelines for the International Menopause Society.

"I think the main finding is, the major indication for HRT is symptoms," Lobo said. "Young" refers to women 50 to 59 at the start of menopause, he said.

The recommendations may help to settle the controversy that arose in 2002 on the heels of an alarming report from the large-scale Women's Health Initiative (WHI). That study, which began as a prevention trial for heart disease, concluded that HRT did not protect the heart and that its risks outweighed the benefits for preventing chronic disease.

But when the menopause society's writing group reviewed the WHI and additional evidence, they concluded HRT is generally safe for most women at the time of menopause.

Also, by relieving bothersome menopausal symptoms such as hot flashes and vaginal dryness, Lobo said HRT may improve quality of life and sexuality. It may also help prevent osteoporosis and colon cancer, the authors said.

"And in these women under 60, there is early evidence there is benefit for heart health as well," Lobo said.

Because HRT treatment is highly individual, a woman's decision to start or continue treatment should be discussed with her doctor, the authors said.

The updated recommendations, published in the journal Climacteric, also urge women using HRT to review the decision annually with their doctor and to discontinue it every few years to see if symptoms return.

Short-term use is advised, just for as long as needed for symptom relief and at the lowest dose that relieves symptoms.

One reason for the reversal is that the average age of the participants in the earlier study was 63, which is typically after menopausal symptoms end, and an unusual time to start hormone replacement.

"The pendulum swung back from its peak negative sentiment following more detailed data from the WHI study that demonstrated the importance of the age at initiation and the good safety profile of HRT in women younger than 60 years," the authors wrote.

"HRT remains the most effective therapy for vasomotor symptoms [such as hot flashes] and urogenital atrophy [including vaginal dryness]," the review said.

"Other menopause-related complaints, such as joint and muscle pains, mood swings, sleep disturbances and sexual dysfunction (including reduced libido) may improve during HRT," they authors continued.

Other findings:

  • Potential risks and side effects increase with age, the experts said. So, women many years past menopause should be especially cautious, although for some of them long-term HRT may be safe, Lobo said.
  • The combination form of HRT, including both estrogen and progesterone, slightly increases the risk of breast cancer. Women with a family history of breast cancer probably should not take it.
  • Women older than 60, who are at increased risk of stroke from HRT, might consider an HRT transdermal patch, which isn't associated with elevated stroke risk.
  • Women who have had a hysterectomy can benefit from HRT in terms of reduced risk of heart disease.

Dr. Elizabeth Poynor, a gynecologist and gynecologic oncologist at Lenox Hill Hospital in New York City, who is familiar with the study, thinks it is sound.

"We are coming full circle with HRT," she said. "We are realizing for some women it really does have benefit. We went from giving HRT to everybody to giving HRT to nobody [after the 2002 findings] to really individualizing it, which is how we should utilize HRT."

HRT, she said, is "definitely not a one-size-fits-all situation, and that is what I like about this position statement."

The menopause society paid for the review and received no money from outside sources.

More information

To learn more about midlife health, visit the American Congress of Obstetricians and Gynecologists.

SOURCES: Roger Lobo, M.D., professor, obstetrics and gynecology, Columbia University, New York City; Elizabeth A. Poynor, M.D., gynecologist and gynecologic oncologist, Lenox Hill Hospital, New York City; World Congress on Menopause, June 10, 2011, Rome, Italy

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