The benefits of hormone therapy outweigh its risks in healthy perimenopausal and early-postmenopausal women with menopause-related symptoms and a low baseline risk of stroke, according to the revised position statement released by the North American Menopause Society.
However, the paper cautioned, that HT should not be prescribed for the prevention of any disease, with the exception of postmenopausal osteoporosis.
HT can be prescribed for the prevention of postmenopausal osteoporosis in women who require drug therapy to maintain bone. “There is strong evidence of the efficacy of [HT] in reducing the risk of postmenopausal osteoporotic bone fracture,” the statement read.
For women at risk of a fracture during the next 5–10 years, HT can be an option—but only after a careful risk/benefit analysis.
The statement is based on an expert panel's review of HT studies published subsequent to the group's 2004 position paper, said Dr. Wulf Utian, executive director of the North American Menopause Society (NAMS) in Cleveland. “In this day and age, the life span of any position statement is a maximum of 2 or 3 years,” Dr. Utian said in an interview. “In the face of so much new information, we felt an update was due.”
The clinical impacts of HT's short- and long-term effects are becoming clearer, especially as additional subanalyses of the Women's Health Initiative (WHI) and the Heart and Estrogen/Progestin Replacement Study (HERS) begin to emerge, he said.
Results of these and other studies enabled more expert consensus in the new paper than was previously possible—most significantly, Dr. Utian said, in the area of cardiovascular disease risk.
“We have modified our stance on level of risk from 2004,” he explained.
“Apart from the increased risk of stroke in the older woman [taking HT], the absolute risk of stroke and heart attack is rare, and we agreed that any evidence of an increase in heart attack in the perimenopausal woman was poor. We have concluded that for the symptomatic woman without a contraindication, the benefits of HT outweigh the risks, and that these women have less cause to fear than the popular perception,” said Dr. Utian.
Two well-publicized, large studies have precipitated much of the current confusion over the safety of HT, appropriate treatment populations, and timing of therapy, the statement said. “The results of WHI and HERS should not be extrapolated to symptomatic postmenopausal women younger than 50 years of age, who initiate HT at that time, as these women were not studied in those trials.”
“We state very clearly there is no cookbook recipe. Each woman has her own potential indications and risk factors, and only a comprehensive evaluation and discussion is going to decide what is most appropriate for that individual,” Dr. Utian stressed.
The NAMS statement is available at www.menopause.org/aboutmeno/consensus.htm
'There is no cookbook recipe. Each woman has her own potential indications and risk factors.' DR. UTIAN