Delfin A. Tan, MD
Department of Obstetrics and Gynecology,
St. Luke’s Medical Center,
Quezon City, Philippines

The latest recommendations regarding the use of hormone therapy in peri- and post- menopausal women by the International Menopause Society are presented in two recent publications.1,2

The IMS is aware of possible geographical variations related to different priorities of medical care, different prevalence of diseases, and country-specific attitudes toward menopause management which may all impact on HT.
  
The recommendations, therefore, are designed to give a global and simple overview of the various aspects of HT that serves as a common platform that could be adapted and/or modified according to regional or local needs. 
 
The IMS has also expressed its opinion through press statements and commentaries issued from time to time in response to current developments in the field.
 
Hormone therapy should be part of an overall strategy in the management of the adult woman. It must be individualized and tailored according to symptoms, the need for prevention of chronic diseases associated with menopause, the woman’s personal and family history, and her preferences and expectations.
 
The risks and benefits of hormone therapy differ for women around the time of menopause compared to those for older women. HT, however, should not be recommended without a clear indication for its use. Dosage should be titrated to the lowest effective dose. There are no reasons to place mandatory limitations on the duration of HT.
 
HT remains the most effective therapy for vasomotor and estrogen-deficient urogenital symptoms. It is effective in preventing bone loss associated with menopause and decreases the incidence of all osteoporosis-related fractures.
 
There is evidence that HT may be cardioprotective if started around the time of the menopause and continued long-term. HT markedly reduces the risk of diabetes and colorectal cancer. Early HT use is associated with a reduced risk of Alzheimer’s disease.
 
The degree of association between breast cancer and HT remains controversial. Women should be reassured that the possible risk of breast cancer associated with HT is small (less than 0.1% per annum). The correlation between mammographic density and the risk of breast cancer does not necessarily apply to the increase in mammographic density induced by HT.
 
Even if the risks of thromboembolism and stroke are statistically increased by HT use, their low prevalence in women under 60 years of age makes the attributable risk extremely small.

Hormone therapy should be part of an overall strategy in the management of the adult woman.

 

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References:
¹ Board of the International Menopause Society, Pines A, Sturdee DW, Birkhäuser MH, Schneider HP, Gambacciani M, Panay N. IMS Updated recommendations on postmenopausal hormone therapy. Climacteric. 2007 Jun;10(3):181-94.
 
² Pines A, Sturdee DW, Birkhauser MH, de Villiers T, Naftolin F, Gompel A, Farmer R, Barlow D, Tan D, Maki P, Lobo R, Hodis H; International Menopause Society. HRT in the early menopause: scientific evidence and common perceptions. Climacteric. 2008 Aug;11(4):267-72.