June 23, 2010
New Scientific Statement Evaluates Benefits And Risks Of Menopausal Hormone Therapy
Endocrine Society Scientific Statements provide education on the scientific basis of disease and its application to the practice of medicine
The Endocrine Society presented its Scientific Statement on menopausal hormone therapy Monday in San Diego, Calif. at ENDO 2010: The 92nd Annual Meeting & Expo. The Scientific Statement, located at http://www.endo-society.org/journals/ScientificStatements/upload/jc-2009-2509v1.pdf, provides a comprehensive, objective evaluation of the benefits and risks associated with menopausal hormone therapy (MHT).MHT is a new term for use of hormones for treatment of menopause and is now used rather than HRT or hormone replacement therapy. The major reasons for starting MHT are to treat hot flashes and other menopausal symptoms. MHT involves the use of one or more of a group of medications designed to boost levels of estrogen in the blood.
In the 1990s, MHT was being used increasingly to treat menopausal symptoms and reduce heart disease risk. The Women's Health Initiative (WHI) Study, a study undertaken to determine whether MHT truly protected against heart disease and whether or not it increased breast cancer risk, reported that MHT led to an increased risk of heart disease, stroke and breast cancer.
New data however suggests that reports from the WHI did not take a key factor into account, time after onset of menopause when MHT was started. The significance of this factor in determining the safety and efficacy of MHT prompted The Endocrine Society to issue the Scientific Statement.
"Before the WHI, MHT was believed to prevent heart disease, fractures, memory loss and dementia in addition to relieving uncomfortable menopausal symptoms," said Richard Santen, MD, professor of medicine at the University of Virginia and chair of the task force that authored the statement. "Following the WHI reports of increased health risks associated with MHT, MHT use declined by 80 percent. New data however shows that these health risks may not apply to all women using MHT, and that MHT may in fact be very beneficial to some women."
New data shows women starting menopausal hormone therapy a short time after onset of menopause at ages 50-59 respond differently than those starting MHT after age 60. Women in the short-time group using MHT for five years experienced a 30-40 percent decrease in mortality, no increased risk of heart disease and 90 percent reduction of menopausal symptoms such as hot flashes or overactive bladder.
"Some women in the short-time group still developed breast cancer but only with the combination of estrogen plus a progestogen, not with estrogen alone. This may be due to the stimulation and uncovering of very small, undiagnosed breast cancers, rather than causing these cancers de novo," said Santen.
"It is important to remember that most women considering MHT are between the ages of 50 and 55 and in this group MHT may have many benefits," said Santen. "Physicians and their patients need to re-think the use of menopausal hormone therapy based on data pertinent to the 50-55 year old and therapy should be individualized based on symptoms and underlying risks of breast cancer and heart disease."
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