Prescribing menopausal hormone therapy: an evidence-based approach
Richa Sood, Stephanie S Faubion, Carol S Kuhle, Jacqueline M Thielen, Lynne T Shuster Division of General Internal Medicine, Women's Health Clinic, Mayo Clinic, Rochester, MN, USA Abstract: The constantly changing landscape regarding menopausal hormone therapy (MHT) has been challenging for...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2014-01-01
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| Series: | International Journal of Women's Health |
| Online Access: | http://www.dovepress.com/prescribing-menopausal-hormone-therapy-an-evidence-based-approach-a15532 |
| _version_ | 1811318698116382720 |
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| author | Sood R Faubion SS Kuhle CL Thielen JM Shuster LT |
| author_facet | Sood R Faubion SS Kuhle CL Thielen JM Shuster LT |
| author_sort | Sood R |
| collection | DOAJ |
| description | Richa Sood, Stephanie S Faubion, Carol S Kuhle, Jacqueline M Thielen, Lynne T Shuster Division of General Internal Medicine, Women's Health Clinic, Mayo Clinic, Rochester, MN, USA Abstract: The constantly changing landscape regarding menopausal hormone therapy (MHT) has been challenging for providers caring for menopausal women. After a decade of fear and uncertainty regarding MHT, reanalysis of the Women's Health Initiative data and the results of recent studies have provided some clarity regarding the balance of risks and benefits of systemic MHT. Age and years since menopause are now known to be important variables affecting the benefit-risk profile. For symptomatic menopausal women who are under 60 years of age or within 10 years of menopause, the benefits of MHT generally outweigh the risks. Systemic MHT initiated early in menopause appears to slow the progression of atherosclerotic disease, thereby reducing the risk of cardiovascular disease and mortality. During this window of opportunity, MHT might also provide protection against cognitive decline. In older women and women more than 10 years past menopause, the risk-benefit balance of MHT is less favorable, particularly with regard to cardiovascular risk and cognitive impairment. For women entering menopause prematurely (<40 years), MHT ameliorates the risk of cardiovascular disease, osteoporosis, and cognitive decline. Nonoral administration of estrogen offers advantages due to the lack of first-pass hepatic metabolism, which in turn avoids the increased hepatic synthesis of clotting proteins, C-reactive protein, triglycerides, and sex hormone-binding globulin. The duration of combined MHT use is ideally limited to less than 5 years because of the known increase in breast cancer risk after 3–5 years of use. Limitations to use of estrogen only MHT are less clear, since breast cancer risk does not appear to increase with use of estrogen alone. For women under the age of 60 years, or within 10 years of onset of natural menopause, MHT for the treatment of bothersome menopausal symptoms poses low risk and is an acceptable option, particularly when nonhormonal management approaches fail. Keywords: hormone therapy, hot flash, flush, menopause |
| first_indexed | 2024-04-13T12:29:10Z |
| format | Article |
| id | doaj.art-afeae123655245f1b6d9acf9205e2953 |
| institution | Directory Open Access Journal |
| issn | 1179-1411 |
| language | English |
| last_indexed | 2024-04-13T12:29:10Z |
| publishDate | 2014-01-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | International Journal of Women's Health |
| spelling | doaj.art-afeae123655245f1b6d9acf9205e29532022-12-22T02:46:54ZengDove Medical PressInternational Journal of Women's Health1179-14112014-01-012014default475715532Prescribing menopausal hormone therapy: an evidence-based approachSood RFaubion SSKuhle CLThielen JMShuster LTRicha Sood, Stephanie S Faubion, Carol S Kuhle, Jacqueline M Thielen, Lynne T Shuster Division of General Internal Medicine, Women's Health Clinic, Mayo Clinic, Rochester, MN, USA Abstract: The constantly changing landscape regarding menopausal hormone therapy (MHT) has been challenging for providers caring for menopausal women. After a decade of fear and uncertainty regarding MHT, reanalysis of the Women's Health Initiative data and the results of recent studies have provided some clarity regarding the balance of risks and benefits of systemic MHT. Age and years since menopause are now known to be important variables affecting the benefit-risk profile. For symptomatic menopausal women who are under 60 years of age or within 10 years of menopause, the benefits of MHT generally outweigh the risks. Systemic MHT initiated early in menopause appears to slow the progression of atherosclerotic disease, thereby reducing the risk of cardiovascular disease and mortality. During this window of opportunity, MHT might also provide protection against cognitive decline. In older women and women more than 10 years past menopause, the risk-benefit balance of MHT is less favorable, particularly with regard to cardiovascular risk and cognitive impairment. For women entering menopause prematurely (<40 years), MHT ameliorates the risk of cardiovascular disease, osteoporosis, and cognitive decline. Nonoral administration of estrogen offers advantages due to the lack of first-pass hepatic metabolism, which in turn avoids the increased hepatic synthesis of clotting proteins, C-reactive protein, triglycerides, and sex hormone-binding globulin. The duration of combined MHT use is ideally limited to less than 5 years because of the known increase in breast cancer risk after 3–5 years of use. Limitations to use of estrogen only MHT are less clear, since breast cancer risk does not appear to increase with use of estrogen alone. For women under the age of 60 years, or within 10 years of onset of natural menopause, MHT for the treatment of bothersome menopausal symptoms poses low risk and is an acceptable option, particularly when nonhormonal management approaches fail. Keywords: hormone therapy, hot flash, flush, menopausehttp://www.dovepress.com/prescribing-menopausal-hormone-therapy-an-evidence-based-approach-a15532 |
| spellingShingle | Sood R Faubion SS Kuhle CL Thielen JM Shuster LT Prescribing menopausal hormone therapy: an evidence-based approach International Journal of Women's Health |
| title | Prescribing menopausal hormone therapy: an evidence-based approach |
| title_full | Prescribing menopausal hormone therapy: an evidence-based approach |
| title_fullStr | Prescribing menopausal hormone therapy: an evidence-based approach |
| title_full_unstemmed | Prescribing menopausal hormone therapy: an evidence-based approach |
| title_short | Prescribing menopausal hormone therapy: an evidence-based approach |
| title_sort | prescribing menopausal hormone therapy an evidence based approach |
| url | http://www.dovepress.com/prescribing-menopausal-hormone-therapy-an-evidence-based-approach-a15532 |
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