New study notes hormone replacement outweighs risk for many women


2013-03-18 13:42

In recent years, the use of hormone replacement therapy (HRT) for menopausal symptoms has declined because women are fearful of an increased risk of cancer and cardiovascular disease. However, a new study has reported that the benefits outweigh the risks for many women. The consensus of seven major United States and international societies focused on menopause and women’s health were published in the journals Climacteric and Maturitas. The consensus also summarized the state of the science on HRT use.

Tobie J. de Villiers, MBChB, from MediClinic Panorama and the Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa and colleagues concluded that HRT is the most effective treatment for menopausal symptoms and that the benefits are likely to outweigh the risks if it is prescribed before the age of 60 years or within 10 years after menopause. They recommended that dose and duration should be individualized, and personal risk factors such as the risk of venous thromboembolism (blood clots), stroke, ischemic heart disease, and breast cancer should guide use of HRT.

The main conclusions listed in the consensus:

  • The benefits of HRT outweigh the risks for the treatment of symptoms associated with menopause if prescribed before the age of 60 years or within 10 years after menopause.
  • HRT may prevent osteoporosis-related fractures in at-risk women before the age of 60 years or within 10 years after menopause.
  • Review of randomized clinical trials and observational data shows that HRT using standard-dose monotherapy with estrogen may decrease coronary heart disease and all-cause mortality in women younger than 60 years and within 10 years of menopause.
  • Oral HRT increases the risk for venous thromboembolism and ischemic stroke, but the absolute risk is rare in women younger than 60 years.
  • Increased risk for breast cancer may be a concern with combination HRT using estrogen and progesterone and may be related to duration of use. The risk is small and decreases after treatment is discontinued.
  • Use of custom-compounded bioidentical hormone therapy is not recommended.
  • HRT should not be used in women who have a history of breast cancer.

The main benefits of HRT are relief from:

  • Hot flashes
  • Night sweats
  • Sleep difficulties
  • Vaginal dryness
  • Anxiety

Usually, hot flashes and night sweats are less severe after a couple of years, especially if hormone therapy is slowly reduced.
A woman's body produces less estrogen during and after menopause, which may affect her bone strength. Hormone therapy may also prevent the development of osteoporosis.

Take home message:
The major risk of cardiovascular disease was found in women who began HRT a number of years after the menopause. One theory is that atherosclerotic plaques formed after the menopause and, when HRT therapy was instituted, these plaques broke loose and caused cardiovascular events. Many studies that noted adverse events from HRT were based on oral estrogen, primarily Premarin. Low dose estrogen patches are now available that contain significantly less estrogen and studies report that they are safer. If you are approaching or in the early phase pof menopause, it would be advisable to discuss HRT with a gynecologist.

References:
Climacteric
Maturitas