Hormone replacement therapy (HRT) is the most effective available treatment for menopause symptoms, according to a consensus statement issued by seven major professional societies.
The risk-benefit balance for HRT tends to be greatest in women younger than 60 or within 10 years after menopause -- not only for relief of menopause symptoms but also for preventing osteoporosis-related fractures, the statement indicated.
Signatories included the American Society for Reproductive Medicine, the Asia Pacific Menopause Federation, the Endocrine Society, the European Menopause and Andropause Society, the International Menopause Society, the International Osteoporosis Foundation, and the North American Menopause Society.
The statement emerged from a November 2012 meeting organized in Paris by the International Menopause Society, with representatives of these organizations. They sought to produce a brief document listing points of mutual agreement, in an effort to counter years of confusion among patients and physicians.
A preamble to the statement also acknowledged that differing recommendations among various women's health organizations had not helped matters, although, as those groups have revised their guidelines, "the differences have become much less."
"These core recommendations do not replace the more detailed and fully referenced recommendations prepared by individual national and regional societies," it said.
The consensus recommendations included the following:
- Among women younger than 60 or within 10 years after menopause, estrogen-alone HRT at standard doses "may decrease coronary heart disease and all-cause mortality." Mortality benefits of estrogen plus progestogen in this group are less clear with no increase or decrease in cardiovascular risk.
- For women whose only menopause symptom is vaginal dryness or discomfort during intercourse, low-dose topical estrogen is preferred.
- Estrogen-only HRT is preferred in women after hysterectomy; other women should receive estrogen plus progestogen.
- Venous thromboembolism and ischemic stroke risk increases with oral HRT but the absolute risk remains low in women younger than 60. Such risks may be smaller with transdermal therapy.
- HRT is not recommended in breast cancer survivors.
- Custom-compounded "bioidentical" hormone therapy is not recommended.
The statement was less direct on the controversial question of breast cancer risk associated with HRT. Calling it "a complex issue," the statement indicated that the risk has been identified mainly with estrogen-progestogen combination therapy and is also a function of treatment duration.
It added, "The risk of breast cancer attributable to [HRT] is small and the risk decreases after treatment is stopped." But the statement did not provide specific recommendations on HRT types or durations to minimize the risk.
The authors also urged that HRT "is an individual decision" that should take account of patient's personal preferences, age, time since menopause, and risk factors for adverse outcomes. Hormone doses and therapy duration should also be individualized.
The journals and Maturitas were to publish the full statement online Thursday.