Hormone Replacement Replaced
Hormone Therapy Focus: Short-Term Treatment of Menopause Symptoms
Experts Agree -- to a Point continued...
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.
Young Women with Hysterectomies
The experts seem to agree that there's another group of women who benefit from long-term estrogen therapy.
"It's an entirely different situation for the younger woman with a hysterectomy," Rebar says. "Most of us believe that in those situations of premature menopause, estrogen is truly being used for replacement in women who would naturally have the hormone. But there is no data."
And the Experts Disagree, Too
The NAMS panel also failed to agree on a number of things. These include:
- What is "short-term" HT? What is "long-term" HT? The only agreement on this question is that no uniform time applies to all women.
- Does HT increase the short-term risk of heart disease? It's not clear, although women who already have heart disease should not begin HT.
- How long should a woman with menopausal symptoms take HT?
- Is there a best way to stop taking HT? Some say stop abruptly, some say taper the dose.
- Does it matter whether you take continuous combined estrogen/progestin or continuous estrogen with sequential progestin/progesterone?
- Does HT enhance a woman's quality of life?