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Hormone Therapy, Finally the Experts Agree

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It's been 10 years since the Women's Health Initiative hormone trials announced that there was an increase in breast cancer, heart attacks and strokes with the use of hormone therapy. Headlines warned women against taking hormone therapy, without fully disclosing all the facts and issues pertaining to this study.

The public fear was so great that within a year of the WHI publication, 66 percent of hormone therapy users aged 50 and older discontinued therapy. There was so much confusion regarding the safety of hormone therapy, even the experts did not agree.

Dr. Margery Gass, Executive Director of the North American Menopause Society (NAMS), says:

We believe that too many symptomatic women are missing out on the proven benefits of hormone therapy because the results of the WHI, which studied the long-term use of hormones to prevent chronic disease, were misinterpreted for women with menopausal symptoms ... Women and clinicians are frustrated by the many conflicting recommendations.

Finally, 15 top medical organizations have come together to issue a statement of agreement regarding the benefits of hormone therapy for symptomatic menopausal women.

The North American Menopause Society states: "We believe that women deserve to know the facts that can inform their decision to use or not to use hormone therapy."

Ladies, here are the latest hormone therapy recommendations:

Overview message:

Systemic hormone therapy is an acceptable option for relatively young (up to age 59 or within ten years of menopause) and healthy women who are bothered by moderate to severe menopausal symptoms. Individualization is key in the decision to use hormone therapy.

Consideration should be given to the woman's quality-of-life priorities as well as her personal risk factors such as age and time since menopause. Risk of blood clots, heart disease, stroke and breast cancer should also be acknowledged.

Symptom Relief Benefits: "Systemic hormone therapy is the most effective treatment for most menopausal symptoms, including vasomotor symptoms and vaginal atrophy."

Women who still have a uterus need to take a progestogen along with the estrogen to prevent cancer of the uterus. Women who have had their uterus removed can take estrogen alone.

"Local estrogen therapy is effective and preferred for women whose symptoms are limited to vaginal dryness or discomfort with intercourse; low-dose vaginal estrogen therapy is recommended in this situation."

Duration of therapy:

The lowest dose of hormone therapy should be used for the shortest amount of time to manage menopausal symptoms. Although fewer than five years is recommended for estrogen with progestogen therapy, duration should be individualized. For estrogen therapy alone, more flexibility in duration of therapy may be possible.

Breast Cancer:

An increased risk of breast cancer is seen with five years or more of continuous estrogen with progestogen therapy, possibly earlier with continuous use since menopause. The risk is real but not great, and the risk decreases after hormone therapy is discontinued.

Vascular Risks: There have been many other studies this past decade focusing on hormone therapy and heart disease, revealing that menopausal women between the ages of 50 to 59 who took hormone therapy for less than 10 years did not have an increased risk of adverse effects.

"Transdermal estrogen therapy and low-dose oral estrogen therapy have been associated with lower risks of blood clots and stroke than standard doses of oral estrogen."

Leading medical societies devoted to the care of menopausal women agree that the decision to initiate hormone therapy should be for the indication of treatment of menopause-related symptoms. Although research is ongoing and these recommendations may be modified over time, there is no question that hormone therapy has an important role in managing symptoms for women during the menopausal transition and in early menopause.

There is a growing body of evidence that formulation, route of administration, and timing and duration of therapy may produce different effects.

Every woman is different, and treatment must be individualized. There is no "one size fits all" when it comes to managing menopause symptoms.

Finally, the experts agree on key points regarding the safety and role of hormone therapy in menopause management based on scientific evidence collected over the last ten years.

By Staness Jonekos
Co-Author,
The Menopause Makeover

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