EMAS position statement: managing obese postmenopausal women.
BACKGROUND
Obesity is a public health problem, with overweight individuals representing approximately 20% of the adult world population. Postmenopausal status is associated with higher prevalence of obesity, as 44% of postmenopausal women are overweight, among whom 23% are obese. Obesity often co-exists with other diseases, the most important being diabetes mellitus, dyslipidemia and hypertension. Furthermore, obesity increases the risk of gynecologic cancer, cardiovascular disease, venous thromboembolism, osteoarthritis and chronic back pain.


OBJECTIVE
To formulate a position statement on the management of the menopause in obese women.


METHODS
Literature review and consensus of expert opinion.


CONCLUSIONS
Obese women seeking hormone therapy should be evaluated for their individual baseline risk of developing breast cancer, cardiovascular disease and venous thromboembolism. These risks should be weighed against expected benefit from symptom relief, improved quality of life and osteoporosis prevention. The lowest effective estrogen dose should be used (CEE 0.300-0.400 mg or estradiol 0.5-1 mg orally daily or 25-50 microg estradiol transdermally). With regard to progestogens, although no RCT data exist, there are observational studies showing that micronized progesterone or dydrogesterone may have a better risk profile with respect to breast cancer risk. There are no RCT data comparing various progestogens with regard to VTE risk. There are observational data, however, suggesting that micronized progesterone or pregnane derivatives may be associated with a lower VTE risk in postmenopausal women taking HT compared to nonpregnane derivatives. There is a rationale in suggesting the use of transdermal HT in obese women, since this route of administration has been associated with a lesser risk of venous thromboembolism than oral therapy.
Lambrinoudaki
Irene
I
2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, GR-11528 Athens, Greece. ilambrinoudaki@aretaieio.uoa.gr
Brincat
Marc
M
Erel
C Tamer
CT
Gambacciani
Marco
M
Moen
Mette H
MH
Schenck-Gustafsson
Karin
K
Tremollieres
Florence
F
Vujovic
Svetlana
S
Rees
Margaret
M
Rozenberg
Serge
S
D001943:Breast Neoplasms / Q000517:prevention & control*; D004333:Drug Administration Routes; D015914:Estrogen Replacement Therapy / Q000009:adverse effects / Q000379:methods; D004967:Estrogens / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D009765:Obesity; D017698:Postmenopause; D011372:Progestins / Q000008:administration & dosage*; D012307:Risk Factors; D012955:Societies, Medical; D054556:Venous Thromboembolism / Q000517:prevention & control*
D004967:Estrogens; D011372:Progestins