Menopause Hormone Therapy Current Evidence and Clinical Use

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Menopause Hormone Therapy Current Evidence and Clinical Use

Journal Title: Interventions in Gynaecology and Women’s Healthcare - Year 2018, Vol 2, Issue 2

Abstract

Spontaneous menopause, the permanent cessation of menstruation caused by loss of ovarian function, occurs at a mean age of 51-52 years. As life expectancy increases,women are living far longer after menopauseonset than in the past.Climacteric syndrome is common but it is not always necessary to treat women in the transition and in menopause. However, hormonal changes can be associated with symptoms; the most common are hot flashes and night sweats. Others like dyspareunia, vaginal dryness, mood swings and sexual dysfunction can frequently appear. There is an increase in bone resorption on occasions leading toosteopenia and osteoporosis. Women who are severely symptomatic, 25-30% of all menopause women, have their quality of life affected [1]. In addition to this deleterious effect, menopausal womenalso have an increased prevalence of coronary heart disease and obesity [2].Menopause hormone therapy (MHT) is the most effective treatment for symptoms. It is the gold standard for relievingvasomotorsymptoms (VSM) and also it improves other problems related with menopause. Furthermore, MHT is effective in preventing the loss of bone massand in reducing cardiovascular accident [3]. Thus, there is a global consensus statement on MHT that concluded that for symptomatic women the benefits are higher than risks before 60 years old or within 10 years after menopause [4-6]. The most prescribed therapy for menopause in the USA was a combination of conjugated equine estrogens (CEE) plus medroxyprogesterone acetate (MPA) but breast cancer risk was a major safety concern with this regimen.The Women’s Health Initiative (WHI) was a randomized, controlled trial study designed to determine the benefits and risks of MHT taken for chronic disease prevention by healthy postmenopausal women. The study ended early due to findings of increased relative risk of breast cancer after 5.2 years of treatment [6]. CEE alone did not increase the risk of breast cancer in the WHI study, and after 7 years of intervention, it reduced breast cancer risk at the 6year follow-up [7]. In 2016 the WHI authors wrote a paper explaining maybe there was a mistake in the interpretation of this study; they remarked the possible role of the progesterone in increasing the risk of breast cancer and stimulated the need to develop safer alternatives [8]. Furthermore, in 2017 they published a study concluding MHT was associated with lower mortality from all causes after 18 years of follow-up of WHI study patients[9].

Authors and Affiliations

Baquedano L, Lapresta M, Colmenarejo F

Keywords

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EP ID EP573227
DOI 10.32474/IGWHC.2018.02.000134
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