Recommendations on hormone therapy in peri- and postmenopause

Unresolved issues

The Expert Panel found that data were insufficient to answer these questions:

• Should women who are doing well on long-term hormone therapy (HT) discontinue?
  
• Is there a best way to discontinue HT?
  
• Does a continuous-combined EPT regimen have an effect different from continuous estrogen with sequential progestogen?
  
• Is HT associated with early risk of coronary heart disease?
  

New recommendations

Duration

• ET/EPT can be used for a time consistent with treatment goals and provided the patient is monitored regularly; there was no stipulation on when to reduce or stop therapy.
  

• So-called “bioidentical hormones” should be considered to have the same safety issues as traditional postmenopausal hormone therapy until clinical trials can specify their safety and effectiveness. (The statement refers to custommade alternatives to FDA-approved estrogen and progestogen formulations.)
  

• The risk of breast cancer probably increases with EPT use but not with ET use.
  

• The role of both ET and EPT in primary prevention of coronary heart disease remains unclear, especially in younger women starting therapy early and continuing for a number of years; however, until that evidence is forthcoming, ET or EPT should not be used for primary or secondary prevention of coronary heart disease.
  

Renewed recommendations

Hormones for hot flashes

• Strong endorsement to use ET/EPT for menopause-related symptoms such as hot flashes.
  

• ET or EPT should be limited to the lowest effective dose.
  

The complete report is in the NAMS official journal, Menopause (2004;11:589–600) and can be accessed at www.menopause.org

Unresolved issues

The Expert Panel found that data were insufficient to answer these questions:

• Should women who are doing well on long-term hormone therapy (HT) discontinue?
  
• Is there a best way to discontinue HT?
  
• Does a continuous-combined EPT regimen have an effect different from continuous estrogen with sequential progestogen?
  
• Is HT associated with early risk of coronary heart disease?
  

New recommendations

Duration

• ET/EPT can be used for a time consistent with treatment goals and provided the patient is monitored regularly; there was no stipulation on when to reduce or stop therapy.
  

• So-called “bioidentical hormones” should be considered to have the same safety issues as traditional postmenopausal hormone therapy until clinical trials can specify their safety and effectiveness. (The statement refers to custommade alternatives to FDA-approved estrogen and progestogen formulations.)
  

• The risk of breast cancer probably increases with EPT use but not with ET use.
  

• The role of both ET and EPT in primary prevention of coronary heart disease remains unclear, especially in younger women starting therapy early and continuing for a number of years; however, until that evidence is forthcoming, ET or EPT should not be used for primary or secondary prevention of coronary heart disease.
  

Renewed recommendations

Hormones for hot flashes

• Strong endorsement to use ET/EPT for menopause-related symptoms such as hot flashes.
  

• ET or EPT should be limited to the lowest effective dose.
  

The complete report is in the NAMS official journal, Menopause (2004;11:589–600) and can be accessed at www.menopause.org

Unresolved issues

The Expert Panel found that data were insufficient to answer these questions:

• Should women who are doing well on long-term hormone therapy (HT) discontinue?
  
• Is there a best way to discontinue HT?
  
• Does a continuous-combined EPT regimen have an effect different from continuous estrogen with sequential progestogen?
  
• Is HT associated with early risk of coronary heart disease?
  

New recommendations

Duration

• ET/EPT can be used for a time consistent with treatment goals and provided the patient is monitored regularly; there was no stipulation on when to reduce or stop therapy.
  

• So-called “bioidentical hormones” should be considered to have the same safety issues as traditional postmenopausal hormone therapy until clinical trials can specify their safety and effectiveness. (The statement refers to custommade alternatives to FDA-approved estrogen and progestogen formulations.)
  

• The risk of breast cancer probably increases with EPT use but not with ET use.
  

• The role of both ET and EPT in primary prevention of coronary heart disease remains unclear, especially in younger women starting therapy early and continuing for a number of years; however, until that evidence is forthcoming, ET or EPT should not be used for primary or secondary prevention of coronary heart disease.
  

Renewed recommendations

Hormones for hot flashes

• Strong endorsement to use ET/EPT for menopause-related symptoms such as hot flashes.
  

• ET or EPT should be limited to the lowest effective dose.
  

The complete report is in the NAMS official journal, Menopause (2004;11:589–600) and can be accessed at www.menopause.org