Yorkshire Menopause Group

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And 10 years on in North America......
18 July 2012

 

15 Top Medical Organizations Agree on Hormone Therapy Use

10 Years Have Passed Since Women's Health Initiative Raised Questions

(July 9, 2012) — After 10 years of debate regarding the risks and benefits of hormone

therapy, 15 top medical organizations have come together to issue a statement of agreement

regarding the benefits of hormone therapy for symptomatic menopausal women. It was

July 9, 2002, when the controversial, highly publicized Women's Health Initiative (WHI)

published its assessment of hormone therapy for the prevention of chronic disease and

concluded that risks exceeded benefits. The new joint statement, prepared by The North

American Menopause Society (NAMS), the American Society for Reproductive Medicine

(ASRM), and The Endocrine Society, concludes that hormone therapy is still an acceptable

treatment for menopausal symptoms. This statement has been endorsed by 12 other leading

organizations in women's health.

The purpose of this statement is to reassure women and their providers that hormone therapy is

acceptable and relatively safe for healthy, symptomatic, recently postmenopausal women. Over

the last 10 years, there has been a complete abandonment of hormone therapy in some settings

accompanied by reluctance to treat women who would benefit from relief of their symptoms.

As a result, some women have sought unproven alternative therapies.

"We want to emphasize the difference between taking hormone therapy short-term for treatment

of menopausal symptoms versus taking hormone therapy for prevention of chronic diseases.

Many women can safely take hormone therapy for relief of menopausal symptoms when they

work closely with their provider to assess their personal risks and benefits," said Dr. Margery

Gass, Executive Director of NAMS. "Women and clinicians have been frustrated by the many

conflicting recommendations over the past 10 years. This statement should be reassuring to all."

Roger Lobo, MD, Past President of the American Society for Reproductive Medicine added,

"Physicians can help patients determine, based on their own particular characteristics and

history, whether or not they are good candidates for hormone therapy and what type of HT will

provide them the greatest relief at the lowest risk. A decade of research and analysis has shown

us that the generalized conclusions of the WHI do not apply to younger women at the beginning

of the menopausal transition."

"The results of the WHI and the conflicting reports that followed led many women to believe

hormone therapy may not be a safe treatment for menopausal symptoms," said Janet E. Hall,

MD, immediate Past President of The Endocrine Society. "We want women to know that there

are options out there for relief of their menopausal symptoms. The level of risk depends on the

individual, her health history, age, and the number of years since her menopause began."

When it comes to the safety and effectiveness of hormone therapy, one commonly heard lament

is, "Even the experts don't agree." This statement was prepared to address this misperception by

presenting evidence

-based key concepts about hormone therapy to assist women and their

clinicians in making informed decisions about use of hormone therapy when appropriate.

Major points of agreement among the societies include:

Hormone therapy is an acceptable option for the relatively young (up to age 59 or within

10 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.

If women have only vaginal dryness or discomfort with intercourse, the preferred

treatments are low doses of vaginal estrogen.

Women who still have a uterus need to take a progestogen (progesterone or a similar

product) along with the estrogen to prevent cancer of the uterus. Women who have had

their uterus removed can take estrogen alone.

Both estrogen therapy and estrogen with progestogen therapy increase the risk of blood

clots in the legs and lungs, similar to birth control pills, patches, and rings. Although the

risks of blood clots and stroke increase with either type of hormone therapy, the risk is

rare in women ages 50-59.

An increased risk in breast cancer is seen with 5 or more years of continuous estrogen

with progestogen therapy, possibly earlier. The risk decreases after hormone therapy is

stopped.

The statement is being published in the journals of The North American Menopause Society,

the American Society for Reproductive Medicine, and The Endocrine Society and has been

endorsed by the Academy of Women's Health, the American Academy of Family Physicians,

the American Academy of Physician Assistants, the American Association of Clinical

Endocrinologists, the American Medical Women's Association, the Asociación Mexicana para el

Estudio del Climaterio, the Association of Reproductive Health Professionals, the National

Association of Nurse Practitioners in Women's Health, the National Osteoporosis Foundation,

the Society for the Study of Reproduction, the Society of Obstetricians & Gynaecologists of

Canada, and the SIGMA Canadian Menopause Society.

The joint hormone therapy statement can be accessed on the websites of The North American

Menopause Society (www.menopause.org), the American Society for Reproductive Medicine

(www.asrm.org), and The Endocrine Society (www.endo-society.org).

Founded in 1989, The North American Menopause Society (NAMS) is North America's leading

nonprofit organization dedicated to promoting the health and quality of life of all women during midlife

and beyond through an understanding of menopause and healthy aging. Its multidisciplinary membership

of 2,000 leaders in the field—including clinical and basic science experts from medicine, nursing,

sociology, psychology, nutrition, anthropology, epidemiology, pharmacy, and education—makes NAMS

uniquely qualified to serve as the definitive resource for health professionals and the public for accurate,

unbiased information about menopause and healthy aging. To learn more about NAMS, visit our website:

www.menopause.org

The American Society for Reproductive Medicine, founded in 1944, is an organization of 8,000

physicians, researchers, nurses, technicians and other professionals dedicated to advancing knowledge

and expertise in reproductive biology. Affiliated societies include the Society for Assisted Reproductive

Technology, the Society for Male Reproduction and Urology, the Society for Reproductive

Endocrinology and Infertility, the Society of Reproductive Surgeons, and the Society of Reproductive

Biologists and Technologists. Website: www.asrm.org

Founded in 1916, The Endocrine Society is the world's oldest, largest and most active organization

devoted to research on hormones and the clinical practice of endocrinology. Today, The Endocrine

Society's membership consists of over 15,000 scientists, physicians, educators, nurses and students

in more than 100 countries. Society members represent all basic, applied, and clinical interests in

endocrinology. The Endocrine Society is based in Chevy Chase, MD. To learn more about the Society

and the field of endocrinology, visit our website: www.endo-society.org.

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