The International Menopause Society has updated its recommendations on hormone replacement therapy and says it is safe for most women going through menopause.

The updated recommendations were released at the 13th World Congress on Menopause in Rome on June 10 simultaneously with publication in Climacteric. (June 2011;14:302-320).

The new evaluation of evidence confirms that treatment needs to be tailored to the individual woman, but that most going through menopause need have few worries about safety and most who suffer from menopausal symptoms will benefit from taking HRT.

It says risks associated with HRT are small, but tend to increase as a woman gets older. It says women taking combined HRT (estrogen and progesterone) to help them go through the menopause have slightly increased risks of breast cancer. 

HRT is also associated with a higher risk of stroke in women over 60.  It suggests women who wish to take HRT but who may be at increased risk of stroke might consider transdermal HRT, which does not seem to increase the risk of stroke.Australasian Menopause Society spokeswoman and acting president Dr Christine Read said:  

“The International Menopause Society has released a recommendation based on expert opinion that hormone replacement therapy is safe for most women going through menopause. HRT IS safe to use. Our understanding about the risks and benefits of HRT has grown enormously over the past 10 years and we now know that it is more useful and safer to use in younger menopausal women experiencing symptoms compared to older women.

“We also have a greater understanding of the health risks that face women in their later years such as breast and other cancers, heart disease, stroke and osteoporosis and their relationship to menopause.”

Dr Read said it was good news for Australian doctors.

“Having good evidence and the weight of expert opinion in their use of HRT is important in providing them with the confidence to prescribe the medication for menopausal women who really need treatment of their symptoms. It sets out clearly and concisely the latest information on which women can use hormone replacement and when.”

Dr Read answer questions
What is the main message from this?

Hormone replacement therapy IS safe to use. Our understanding about the risks and benefits of hormone replacement therapy has grown enormously over the past 10 years and we now know that it is more useful and safer to use in younger menopausal women experiencing symptoms compared to older women. We also have a greater understanding of the health risks that face women in their later years such as breast and other cancers, heart disease, stroke and osteoporosis and their relationship to menopause.

What is new about this..the new thing?

The International Menopause Society has released a recommendation based on expert opinion  that hormone replacement therapy is safe for most women going through menopause. Hormone replacement therapy is the most effective treatment for women who have hot flushes, night sweats, insomnia and some other menopausal symptoms. Women have been afraid to use HRT over the past decade due to concern about health risks with this therapy and many have suffered a poor quality of life as a result. Evidence now says that women who are in their forties and fifties and less than 10 years since menopause have small risks from the use of HRT.

The publication of the first Women’s Health Initiative (WHI) report in 2002 raised alarms about the safe use of HRT. However, recent and more detailed interpretations of the WHI study, plus additional work from other sources, has indicated that any risks of HRT are small, and those which exist are mostly associated with older women – not mainly those going through the menopause. Because of this recent evidence, the International Menopause Society (IMS) has updated its recommendations on the use of HRT.  

 The main findings are

That a woman’s decision to take or to stay on HRT is not a simple yes or no, but needs to be agreed with her physician in the light of individual circumstances and as part of an overall health strategy.

Most women who have menopausal symptoms will benefit, and most menopausal women have little to fear from adverse effects of HRT.

Each woman is different, and her decision to take HRT will carry different benefits and risks, depending on such things as severity of symptoms, age and family history. As a woman grows older, her risks seem to increase, and so women long past the menopause should take greater care

Does it just confirm what we previously new or is it a better review providing more evidence etc?

New evidence has been accumulating over the past ten years, since the original WHI study was published. More detailed information has emerged from these studies about younger menopausal women, generally those who are moving into menopause and those who are recently postmenopausal. Many studies have now reported that the women who need treatment most, the women who are aged up to 60years and within 10 years of menopause, face few risks from HRT and can safely use it. There is additional evidence about benefits from different forms of treatment such as transdermal therapy and different progestogens.

Will there still be women concerned about getting breast cancer from  HRT and what's the message to them? Which women are more likely to get breast cancer from HRT so should avoid it?

Women will always be concerned about breast cancer and should follow the guidelines for good care, which includes regular mammograms from the age of fifty. It is a disease that increases in incidence with age.  There is now evidence from the original WHI study that oestrogen alone therapy, usually taken by women who have had a hysterectomy, used for 7 years does not increase the risk of breast cancer (and women would generally be recommended to use HRT for 5 years or less).  In women using combined oestrogen and progestogen hormone replacement therapy, the risk is smaller than one extra cancer per 1000 women per year of use. Women with higher risks of breast cancer include those with a strong family history of breast and ovarian cancer occurring in mothers, sisters and daughters who were younger than menopause at the time of diagnosis. Lifestyle issues such as obesity and higher rates of alcohol use also play a part in the genesis of breast cancer. 

Is it likely to change practice by Aussie doctors..does it mean they can more safely recommend it now?

This is good news for Australian doctors. Having good evidence and the weight of expert opinion in their use of HRT is important in providing them with the confidence to prescribe the medication for mmenopausal women who really need treatment of their symptoms. It sets out clearly and concisely the latest information on which women can use hormone replacement and when.

For full text of recommendations/paper see:

http://www.imsociety.org/updated_ims_recommendations.php?SESSID=p0t2mv95iocmrqvpvddk1op1f2

For conference details see  http://www.imsroma2011.com/

Content Updated 10 June 2011