Apr 10
20
New data released on hormone replacement therapy
Based on the best available evidence, “Estrogen and progestogen use in postmenopausal women: 2010 position statement of The North American Menopause Society” has just been released. Each section of the previous paper was reviewed by an Advisory Panel of seventeen clinicians and researchers expert in this area of women’s health using new studies and findings. The paper was then approved by the NAMS Board of Trustees.
Specifically, the sections on breast cancer, cognitive aging/decline and dementia, coronary heart disease, stroke, and discontinuance received special attention in light of recently published literature. New sections have been added on hormone therapy (HT) and ovarian and lung cancer.
Overall, “current evidence supports a consensus regarding the role of [hormone therapy] in postmenopausal women when potential therapeutic benefits and risks around the time of menopause are considered,” experts wrote in the position statement. Recommendations further stress HT research and an individualized approach to treating postmenopausal patients.
“There is clearly a need for HT in a certain population. There are a small percentage of women who are highly symptomatic at menopause, and they will benefit the most,” Gass said. “For them, the small risks associated with HT would seem reasonable and acceptable.”
New additions
The new section on ovarian cancer states that the association between ovarian cancer and HT beyond five years would fall into the rare or very rare category but “might be a countering point for women who do have ovarian cancer in her family,” Gass said.
“There are conflicting published data, but some large, observational trials have suggested a weak association between HT and ovarian cancer,” she said. For example, “data from the Women’s Health Initiative did not show a statistically significant relationship.”
The position statement also includes a new section detailing the risks of lung cancer with HT, an association that can be “nebulous and confusing,” according to Gass.
Although overall data from the Women’s Health Initiative suggested an increase in the growth of lung cancer and mortality in women who smoked, data from other studies suggested that HT may actually prevent lung cancer in a younger population (ages 60 years and younger).
“The take-home point here is to be cautious with women who are smoking and using hormones, and to counsel women ahead of time that they should quit smoking if they plan to use combined estrogen/progestogen therapy,” Gass said.
Updated recommendations
According to the position statement, natural menopause has little effect on cognitive function or memory performance, despite previous speculation.
Although the risk for developing dementia increases with age, “both men and women experience increased memory lapses with age,” Gass said. “There is not a particular decline in cognition for women at menopause.”
However, the statement said initiating HT in women aged 65 years and older appears to increase the incidence of dementia.
Concerning mood and depression, the consensus among NAMS experts is that depression is no more common after menopause than before its onset. There is mixed evidence explaining the effect of HT on depression, with certain studies suggesting improved mood and others reporting no change.
The NAMS statement also stressed the value of topical estrogen use in postmenopausal women, particularly for complaints of vaginal problems, such as symptomatic dryness and pain with intercourse.
“Estrogen can be effective when it comes to dyspareunia,” Gass said. “It is generally assumed that applying a topical preparation directly to the vagina is safer than oral estrogen or skin patches. There may be women who want to use vaginal treatment longer than they would use systemic therapy for hot flashes, which gradually get better on their own.”
Conclusions
Recent data support the initiation of HT around the time of menopause to treat menopause-related symptoms; to treat or reduce the risk of certain disorders, such as osteoporosis or fractures in select postmenopausal women; or both. The benefit-risk ratio for menopausal HT is favorable for women who initiate HT close to menopause but decreases in older women and with time since menopause in previously untreated women.
Sources: North American Menopause Society. Menopause. 2010;17:242-255. ( Read the entire position statement here) and endocrinetoday.com
