5 July 2010
The Endocrine Society (USA) issued a scientific statement titled “Postmenopausal Hormone Therapy: An Endocrine Society Scientific Statement” that was published in the July 2010 issue of the Journal of Clinical Endocrinology & Metabolism (JCEM). This statement evaluates benefits and risks for postmenopausal hormone replacement therapy (HRT), now known as menopausal hormone therapy (MHT).
MHT was in widespread use in the 1990’s due to the belief that it prevented heart disease, fractures, memory loss and dementia in addition to its established role in relieving uncomfortable menopausal symptoms. This situation changed drastically in 2002 mainly due to the publication of the Women’s Health Initiative (WHI) Study that showed that MHT was actually associated with an increased risk for heart disease, stroke, and breast cancer. It was reported then that MHT use declined as much as 80% from before.
Despite its huge impact, WHI nevertheless had its criticisms. The average age of the study group, 63 years, was rather advanced. Women typically contemplate initiating MHT between the ages of 50 to 54 years, and this group only made up 3.5% of the total participants in that study. WHI also did not consider menopausal symptom relief amongst these patients. Data from later studies evaluating the effects of MHT in women aged 50 to 55 years have thus been taken into consideration in issuing this latest scientific statement.
Recent evidence suggests that the afore mentioned health risks may not be applicable to all women using MHT. An important factor to consider is the time after onset of menopause when MHT is started, a factor not considered in the WHI assessment of MHT safety and efficacy.
According to the findings of Santen et al in their study published in the JCEM, women who begin MHT a short time after the onset of menopause at ages 50 to 59 years actually appear to benefit from that treatment. It is further evidenced that women in the short-time group using MHT for 5 years had a 30% to 40% reduction in mortality risk and no increased cardiovascular disease risk. In addition, they had a 90% decrease in hot flashes, overactive bladder, or other menopausal symptoms.
A very large portion of the anxiety among perimenopausal women is the risk of occurrence of breast cancer. Santen et al found that some patients who utilized MHT even in its short-time form nevertheless developed this dreaded disease. However, this only applied to those who used the combination of estrogen plus a progestogen and not with estrogen alone. They postulate that this may have been due to the stimulation and uncovering of very small, undiagnosed breast cancers, rather than de novo cancers.
In summary, the Endocrine Society states urges physicians and their patients to re-think the use of MHT based on data pertinent to the 50-55 year old age group and to individualize therapy based on symptoms and underlying risks of breast cancer and heart disease.