Shifren and Schiff have recently published a comprehensive CME review on the role of hormone therapy (HT) in the management of menopause . The article addresses the following issues: vasomotor symptoms, urogenital atrophy, incontinence, osteoporosis, cardiovascular disease, cancer (breast, endometrial, ovarian, colorectal), depression and mood. Each section discusses treatment options including alternative non-hormonal medications and complementary, non-pharmacological therapies. Safety issues and health concerns that are related to HT comprise another main theme of the manuscript. Although the beneficial effects of HT in the early menopause overweigh potential, minimal risks in a healthy population, the age factor and duration of therapy may change this equation. The combination of prescribing the lowest effective dose of HT and using it for the shortest duration, and the prerequisite requirement that the patient will always be well-informed on all issues pertinent to menopause and therapy are the key recommendations of the authors.
Former President of the European Menopause Society and the French Menopause Society (AFEM)
Shifren JL, Schiff I. Role of hormone therapy in the management of menopause. Obstet Gynecol 2010;115:839-55. Published April.
Les Recommandations de LAFEM. Prise en charge de la femme ménopausée: place du traitement hormonal. Reprod Hum Horm 2007;20:384-91.
Pines A, Sturdee DW, Birkhäuser MH, Schneider HPG, Gambacciani M, Panay N, on behalf of the Board of the International Menopause Society. IMS updated recommendations on postmenopausal hormone therapy. Climacteric 2007;10:181-94.
Estrogen and progestogen use in postmenopausal women: 2010 position statement of the North American Menopause Society. Menopause 2010;17:242-55
Fournier A, Berrino F, Clavel-Chapelon F. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Breast Cancer Res Treat 2008;107:103-11
Schneider C, Jick SS, Meier CR. Risk of gynecological cancers in users of estradiol/dydrogesterone or other HRT preparations. Climacteric 2009;12:514-24
Canonico M, Oger E, Plu-Bureau G, et al., for the Estrogen and Thromboembolism Risk (ESTHER) Study Group. Hormone therapy and venous thromboembolism among postmenopausal women: impact of the route of estrogen administration and progestogens: the ESTHER Study. Circulation 2007;115:840-5
Canonico M, Oger E, Conard J, et al. Obesity and risk of venous thromboembolism among postmenopausal women: differential impact of hormone therapy by route of estrogen administration. The ESTHER Study. J Thromb Haemost 2006;4:1259-65