Should symptomatic menopausal women be offered hormone therapy?
Many physicians remain uncertain about prescribing hormone therapy for symptomatic women at the onset of menopause. The American Society for Reproductive Medicine (ASRM) convened a multidisciplinary group of healthcare providers to discuss the efficacy and risks of hormone therapy for symptomatic women, and to determine whether it would be appropriate to treat women at the onset of menopause who were complaining of menopausal symptoms.


RESULTS
Numerous controlled clinical trials consistently demonstrate that hormone therapy, administered via oral, transdermal, or vaginal routes, is the most effective treatment for vasomotor symptoms. Topical vaginal formulations of hormone therapy should be preferred when prescribing solely for the treatment of symptoms of vulvar and vaginal atrophy. Data from the Women's Health Initiative indicate that the overall attributable risk of invasive breast cancer in women receiving estrogen plus progestin was 8 more cases per 10,000 women-years. No increased risk for invasive breast cancer was detected for women who never used hormone therapy in the past or for those receiving estrogen only. Hormone therapy is not effective for the treatment of cardiovascular disease and that the risk of cardiovascular disease with hormone therapy is principally in older women who are considerably postmenopause.


CONCLUSIONS
Healthy symptomatic women should be offered the option of hormone therapy for menopausal symptoms. Symptom relief with hormone therapy for many younger women (at the onset of menopause) with menopausal symptoms outweighs the risks and may provide an overall improvement in quality of life. Hormone therapy should be individualized for symptomatic women. This involves tailoring the regimen and dose to individual needs.
Lobo
Rogerio A
RA
Columbia University, Columbia University Medical Center, New York, NY, USA. ral35@columbia.edu
Bélisle
Serge
S
Creasman
William T
WT
Frankel
Nancy R
NR
Goodman
Neil E
NE
Hall
Janet E
JE
Ivey
Susan Lee
SL
Kingsberg
Sheryl
S
Langer
Robert
R
Lehman
Rebecca
R
McArthur
Donna Behler
DB
Montgomery-Rice
Valerie
V
Notelovitz
Morris
M
Packin
Gary S
GS
Rebar
Robert W
RW
Rousseau
MaryEllen
M
Schenken
Robert S
RS
Schneider
Diane L
DL
Sherif
Katherine
K
Wysocki
Susan
S
D000368:Aged; D015914:Estrogen Replacement Therapy; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D008593:Menopause; D008875:Middle Aged