New guidelines about HRT use urge tailored menopause care

October 8, 2002 in Menopause

New guidelines about HRT use urge tailored menopause care

Women considering taking hormone replacement therapy (HRT) to combat symptoms of menopause must review their individual risk factors with their doctor before making a decision, according to a new set of recommendations issued by a North American Menopause Society panel. The new recommendations, released in Chicago last week, were designed to help women and their doctors sort through confusion about hormones in light of several recent studies that found the risks of combined HRT with both estrogen and progestin outweighed its benefits.

One such study by the National Institutes of Health's Women's Health Initiative, one of the largest and best-designed to date of HRT, was halted this July when women on the therapy were found to have higher risks of heart attack, stroke, blood clots and breast cancer.

While the new recommendations help clarify appropriate HRT use, many questions remain unanswered including how long to prescribe HRT for symptom relief and whether patches, creams and other routes of administration are any safer than pills used in recent studies.

It is more and more important for doctors to individualize their (patients') treatment, say experts. Before these findings were known, the situation was that everyone got one dose, regardless of their size. The recent study data suggest that physicians should be using the lowest dose possible and that treatment should be tailored to the individual.

Treating the symptoms of menopause--such as hot flashes, night sweats and the vaginal dryness that makes sex painful--remains the number-one use for HRT, the recommendations state. The new recommendations stress that combined HRT should not be used to prevent heart disease. Instead, they state, proven alternatives should be considered. It had been hoped that HRT might reduce women's heart disease risk, since women's risk of heart disease after menopause, when hormone levels decline, becomes much higher.

There is still a role for estrogen at low doses and it is still important for the treatment of osteoporosis and the treatment of symptoms, the experts say. Overall, HRT should be given for the shortest length of time possible and lower-than-standard doses should be considered. Hormone patches, creams and other alternative routes of administration may offer an advantage, according to the recommendations, but there is no long-term data on use of such products.

However there was no consensus on how to define "short-term" and "long-term" HRT use and how best to discontinue HRT. Future research needs to focus on whether different estrogens and progestins, different doses and different routes of administration have the same risk profiles as the regimens used in recent studies, the recommendations state.

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