(RxWiki News) Hormones yes, hormones no — the recommendations for menopausal women have swung back and forth in the last 10 years.
The latest review of scientific evidence comes down on the side of yes, especially for younger women who are first entering menopause.
Hormone replacement therapy (HRT) was once recommended for nearly all menopausal symptoms. However, research that indicated higher risks for breast cancer, stroke and blood clots led to a precipitous drop in prescriptions for HRT.
In an extensive review of the most current research, scientists from England found that HRT was the most effective treatment for menopausal symptoms.
The researchers recommend that each woman make an informed decision in collaboration with her doctor.
Shagaf Bakour, Honorary Senior Lecturer and Consultant Obstetrician and Gynaecologist at City Hospital, in Birmingham, England was the co-author of the review.
"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 later maternal age," Dr. Bakour said in a press release. "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 minimized. There are various types and regimens of HRT and healthcare professionals will be able to advise on the suitability of HRT to any woman."
The majority of women experience symptoms of menopause, such as hot flashes and night sweats. These symptoms are due to a decrease in the amount of estrogen produced by the body. As a woman enters menopause, estrogen production drops.
About 70 percent of women experience symptoms for about five years. In some women, symptoms may continue for many years.
HRT provides estrogen in pill, patch or cream form. In some cases, progesterone, another female sex hormone, is also prescribed.
A major study in 2003 — the Women’s Health Initiative Study — reported an increase in breast cancer, stroke and blood clots among women who used HRT. Two other major studies confirmed these findings. As a result, the use of HRT dropped 80 percent, according to this new review.
However, the new review indicates that there is a window of opportunity for younger women in the early phase of menopause when the benefits may be higher than the risks. Most of the women in the three studies that showed increased risks were post-menopausal, with an average age greater than 60.
These older women were already at increased risk of conditions such as breast cancer, heart disease and stroke, according to Dr. Bakour and team. Another, smaller study showed that when younger women received HRT for 10 years immediately after menopause, their risk of cancer, blood clots and stroke was no higher than for women who did not receive HRT.
Women who had premature ovarian insufficiency (menopause before age 45 in developed countries) were at higher risk of cardiovascular disease and osteoporosis, or thinning bones. These women had a lower risk of breast cancer than women who were still menstruating.
Dr. Bakour’s team strongly recommended that women with early menopause receive HRT, at least until the age of 50.
Other women should discuss the risk and benefits of HRT with their physicians. HRT, the researchers stated in the study, is an individual decision and a patient choice.
This review was published in the Dec. 18 issue of The Obstetrician & Gynaecologist.
The review was not funded and the authors did not disclose any conflicts of interest.
