Oct. 3, 2002 - With all the controversy swirling around about hormone replacement therapy (HRT), experts at a meeting of menopause specialists were determined to come up with some useful information that women and their doctors could use. And they did just that.
The panel of experts presented their report today at the 13th annual meeting of The North American Menopause Society (NAMS) held in Chicago.
Specifically, the panel's recommendations are:
- Symptom relief should be the primary reason for taking hormone replacement therapy.
- Progestins should be added to estrogen therapy only to prevent endometrial cancer. If a woman has had a hysterectomy, there is no need for progestins in her hormone therapy.
- Hormone therapy should not be used to prevent heart disease; women should take other measures to reduce that risk.
- Hormone therapies have been shown to help build stronger bones; however, women should weigh the risks of hormone therapy before taking it to prevent osteoporosis.
- A woman should take HRT for the shortest amount of time possible, based on her symptoms, the benefits she's getting from the therapy, and her personal health risks.
- Doctors should consider prescribing low-dose HRT whenever possible.
- Doctors should consider alternate ways of giving HRT other than orally -- such as patches and creams, but should know that studies are not clear on the long-term risks and benefits.
- Every woman's personal health risks should be evaluated before any form of hormone therapy is prescribed. Women should be sure they understand the known risks.
The clinical trials -- the Women's Health Initiative (WHI) and the Heart and Estrogen/Progestin Replacement Study (HERS) -- have provided women with a lot of information in a relatively short period of time, says Wulf Utian, MD, executive director of NAMS. He is also a reproductive endocrinologist and emeritus professor at Case Western Reserve School of Medicine in Cleveland.
All these studies are "confusing enough" for doctors, he tells WebMD. "It's certainly confusing for patients. Our aim is to clear the air a little. We also want to make it clear that we as an expert group still don't have all the answers. In some measure, medicine has always been practiced that way."
Among the issues where the panel could not reach consensus:
- How long women should take hormone therapy for symptom relief.
- The potential preventive benefits that might warrant extended hormone therapy.
- What "long-term" and "short-term" therapy really mean.
In their report, the panelists note that published data from both trials involve only one type of hormone therapy -- estrogen/progestin therapy for women who have not had a hysterectomy.
Also, neither trial looked at women in perimenopause or early menopause -- those between ages 40 and 50, or women younger than 40 going into early menopause.
"This is probably the most frustrating part for everyone, but we didn't feel we had enough data to make consistent recommendations for everyone," says Margery Gass, MD, panel co-chair and associate professor of obstetrics/gynecology at the University of Cincinnati College of Medicine. She also is a WHI investigator.
Indeed, how long should a woman take hormones for symptom relief? "What will happen to the highly symptomatic woman, it's not clear," says Gass. "In my own practice, I have women calling me back, women so miserable without hormones that they are willing to take the risk."