Hormone replacement therapy for younger women?
Hormone replacement therapy (HRT) is the most effective treatment for menopausal symptoms, particularly for younger women at the onset of menopause, suggests a new review.
A re-analysis in data collected in 2007 found giving HRT to women within 10 years of onset of menopause was associated with fewer risks and a reduction in cardiovascular problems. The work was published December 2014 in The Obstetrician & Gynaecologist (TOG).
The review found menopausal symptoms, including hot flashes and night sweats are common, affecting around 70% of women for an average of 5 years. But in about 10% of women, may continue for many years.
Every woman experiences menopause differently. Some feel one or two symptoms mildly while others feel them more severely. Menopausal symptoms can even be debilitating and adversely affect quality of life. HRT, hormone replacement therapy provides low doses of the hormone estrogen, with or without progestogen, replacing hormones a woman slows down producing and eventually no longer produces at the end of her reproductive years.
The risk-benefit ratio of HRT has always been debated and discussed. The Women's Health Initiative Study in 2003 examined the effect of HRT on healthy postmenopausal women with a particular interest in cardiovascular outcomes — reporting an increase in breast cancer, stroke and venous thromboembolism. Consequently, HRT use dropped 80%. But a re-analysis in 2007 demonstrated HRT given within 10 years of menopause was associated with fewer risks and a reduction in cardiovascular problems.
While the Million Women Study in 2001 suggested HRT use increased the risk of breast cancer significantly — and the Cochrane Collaboration review identified an increased risk of similar conditions, authors of the TOG review believe such studies failed to address the effect of HRT in symptomatic younger postmenopausal women. They found benefits of HRT when administered during the early phase of the menopausal transition.
Additionally, the review advises that any woman with contraindications should be offered the option of discussing this further with a menopause specialist. Women with premature ovarian sufficiency should be strongly advised to consider taking HRT until the average menopausal age of 51.4 years, state the authors.
The authors conclude that doctors should not be concerned about discussing the risks and benefits of HRT with women who have menopausal symptoms, or be hesitant to offer a trial of appropriate treatment — emphasising that HRT is a patient's choice.
"Women are sometimes concerned about the increased risk of breast cancer related to HRT. However, this risk is much lower than that associated with other factors such as obesity, alcohol consumption and late maternal age.
"HRT is the most effective treatment for symptoms of the menopause and when HRT is individually tailored, women gain maximum advantages and the risks are minimised.
"There are various types and regimens of HRT and healthcare professionals will be able to advise on the suitability of HRT to any woman."
Shagaf Bakour, Honorary Senior Lecturer and Consultant Obstetrician and Gynaecologist at City Hospital, Birmingham, and co-author of the review.
Jason Waugh, TOG Editor-in-chief added: "The use of HRT is an individual decision, which a woman can only make once she has been given correct information and advice from healthcare professionals."
Hormone replacement therapy (HRT) is the most effective treatment for symptoms of estrogen deficiency. When HRT is individually tailored women gain maximum advantages and the risks are minimised.
Several types and regimens of HRT and different routes of delivery exist. Results from studies using only one type and route may not therefore apply to all users.
The use of HRT is an individual decision, which a woman can only make once she has been given correct information and advice from healthcare professionals.
HRT should be recommended in women with premature ovarian insufficiency with advice to continue until the average age of the menopause at 51.4 years.
To review the current research and the evidence on the use of HRT in women.
Application of the evidence in relation to the management of the symptomatic menopausal woman.
To promote confidence in prescribing HRT in most symptomatic women.
To have a general overview of prescribing in women with relative contraindications.
The use of HRT is a patient informed choice.
Where evidence is limited and quality of life a priority, then a multidisciplinary approach may be necessary and informed written consent documented.
The Obstetrician & Gynaecologist (TOG) is published quarterly and is the Royal College of Obstetricians and Gynaecologists' (RCOG) medical journal for continuing professional development. TOG is an editorially independent, peer reviewed journal aimed at providing health professionals with updated information about scientific, medical and clinical developments in the specialty of obstetrics and gynaecology.
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