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HRT for Menopause Symptoms: Timing Is Everything

By Jennifer Garcia
Medscape Medical News

March 14, 2013 -- Hormone replacement therapy is the most effective treatment for symptoms like hot flashes, and the benefits are likely to outweigh the risks, major medical societies say.

The statement was published in the April issue of the journal Climacteric.

The brief consensus was published on behalf of seven major international and U.S. societies working in menopause and women's health.

Overall, the authors of the statement conclude that the benefits of hormone replacement therapy (HRT) generally outweigh the risks if used for women younger than 60 or within 10 years after menopause. Dose and duration should be decided on an individual basis. Personal risk factors -- such as the risk of a blood clot in a vein, or stroke, heart disease, and breast cancer -- should guide the use of HRT.

Other Key Conclusions

  • HRT may prevent osteoporosis-related fractures in at-risk women before the age of 60 or within 10 years after menopause.
  • A review of multiple studies shows that HRT using estrogen only may lower heart disease and overall death in women younger than 60 and within 10 years after menopause.
  • HRT taken by mouth raises the risk for a blood clot in a vein, and for stroke, but the overall risk is rare in women younger than 60.
  • A higher risk for breast cancer may be a concern with combination HRT using estrogen and progesterone; this may be related to length of use. The risk is small and decreases after treatment is discontinued.
  • Use of custom-compounded bioidentical hormones is not recommended.
  • HRT should not be used in women who have a history of breast cancer.

"The primary indication for using oral HRT is for relief of menopausal hot flashes," says Heidi D. Nelson MD, MPH, research professor at Oregon Health & Science University in Portland. "Its use should be at the lowest dose and shortest duration necessary to improve symptoms and quality of life, and should be individualized."

She says the statement about estrogen-only HRT decreasing heart disease and overall death in women younger than 60 and within 10 years of menopause "is not based on strong evidence. They qualify this statement by phrasing it as 'may decrease,' but this could be misleading. However, it is reassuring that HRT does not increase heart disease in this age group."

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