Hormone Replacement: The Importance of Timing

Authors of the newest consensus statement on menopausal hormone therapy (MHT) have concluded that MHT is the most effective treatment for menopausal symptoms and that benefits are most likely to outweigh the risks if MHT is prescribed before the age of 60 years or within 10 years after menopause. The primary use of oral MHT is for relief of menopausal hot flashes.

Key Conclusions

• MHT is the most effective treatment for vasomotor symptoms associated with menopause at any age, but the benefits outweigh the risks for the treatment of symptoms if prescribed before the age of 60 years or within 10 years after menopause.
• MHT is effective and appropriate for the prevention of 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 standard-dose estrogen-only MHT may decrease coronary heart disease and all-cause mortality in women younger than 60 years and within 10 years of menopause.
• Local low-dose estrogen therapy is preferred for women whose symptoms are limited to vaginal dryness or associated discomfort with intercourse.
• Estrogen as a single systemic agent is appropriate for women after hysterectomy but additional progestogen is required in the presence of a uterus.
• Oral MHT increases the risk for venous thromboembolism and ischemic stroke, but the absolute risk is rare in women younger than 60 years. Lower risk seems apparent with transdermal therapy.
• Increased risk for breast cancer may be a concern with combination MHT using estrogen and a progestogen 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.
• MHT should not be used in women who have a history of breast cancer.

The option of MHT is an individual decision that must be considered in terms of quality of life and health priorities as well as personal risk factors such as age, time since menopause, risk of venous thromboembolism, stroke, ischemic heart disease, and breast cancer.

This statement is being simultaneously published in the journals Climacteric and Maturitas. It is endorsed by The American Society for Reproductive Medicine, The Asia Pacific Menopause Federation, The Endocrine Society, The European Menopause and Andropause Society, The International Menopause Society, The International Osteoporosis Foundation and The North American Menopause Society.

Reference

De Villiers, T. J., Gass, M. L. S., Haines, C. J., Hall, J. E., Lobo, R. A., Pierroz, D. D., & Rees, M. (2013). Global Consensus Statement on Menopausal Hormone Therapy.Climacteric, 16(2), 203-204.