Hormone Replacement Replaced
Hormone Therapy Focus: Short-Term Treatment of Menopause Symptoms
Oct. 8, 2003 -- It's official: Hormone replacement therapy is being replaced.
Say goodbye to HRT. Say hello to the new term: Menopausal hormone therapy (HT). Why?
One reason is the FDA. They've begun a campaign to help women sort through the confusion surrounding the various forms of treatment with estrogen, progestin, and progesterone. The bottom line: Use the smallest dose of HT for the shortest time, says Daniel Shames, MD, director of the FDA's reproductive and urological drugs division.
"Estrogen and progestins should be used by women with menopausal symptoms," Shames tells WebMD. "It is not for the routine prevention of disease in older individuals. There is no evidence that estrogen plus progestin protects against future diseases. But that doesn't mean there's no role for hormone therapy."
Different people are calling hormone therapy different things. But nearly everyone agrees it's a good idea to get away from the idea of replacement, says Robert Rebar, MD, executive director of the American Society for Reproductive Medicine.
"The AMA has said it will be called 'menopausal hormone therapy' and abbreviated 'HT,'" Rebar tells WebMD. "They want to get away from 'replacement.' Replacement was probably inappropriate anyway -- you were 'replacing' something women don't normally have at that age. "
Experts Agree -- to a Point
The North American Menopause Society recently convened a blue ribbon panel on the proper role of HT. Wulf H. Utian, MD, PhD, NAMS executive director and professor of gynecology at Case Western Reserve University, served as chair. When asked what it was like to chair such a diverse panel, Utian laughs.
"There is so much confusion about hormone therapy," Utian tells WebMD. "We health providers and researchers -- we ourselves don't always agree."
But agreement there was, at least up to a point. The major bone of contention is the Women's Health Initiative (WHI) study. It showed that postmenopausal women given Prempro (estrogen in combination with a progestin) have a higher risk of breast cancer. It's a very small risk, but the benefits are even smaller.
"We did agree, first of all, that those who said the final nail has been driven into the coffin of hormone therapy were wrong. They remain an essential group of drugs for treatment of peri and postmenopausal women," Utian says. "Second, we agree the WHI data can't be extrapolated to everyone."
Some other points of agreement:
- The main use of HT is for treatment of moderate and severe menopause symptoms.
- If HT is used to treat vaginal dryness, a local preparation should be used.
- Progestins and progesterone should be used only to protect women taking estrogen from endometrial cancer.
- Estrogen therapy and, to a greater extent, estrogen/progestin therapy increases a woman's risk of breast cancer if used beyond five years. The progestin/progesterone component of this treatment appears to contribute a lot to this risk.
- HT reduces a woman's risk of bone fracture due to osteoporosis.
- Beginning HT after age 65 to prevent dementia is not recommended.
- It's not clear whether different forms of HT have different risks and benefits than oral HT products.
- Any woman considering HT should have a complete health evaluation.
The panel also agreed that there are several groups of women who may benefit from long-term HT:
- Women who believe the benefits of symptom relief outweigh the risks -- especially if they've already tried stopping HT and had their symptoms return.
- Women at high risk of osteoporosis who cannot tolerate other treatments.