Emerging Facade of Menopausal Hormone Therapy

Margaret Rees, D.Phil., M.A., F.R.C.O.G.

Disclosures

Semin Reprod Med. 2010;28(5):351-359. 

In This Article

Abstract and Introduction

Abstract

Menopausal hormone therapy (HT) has been around for 70 years, and in the 1980s and 1990s was considered a universal panacea for women's problems from midlife onward. However, this concept was challenged by the results of the Women's Health Initiative (WHI) and the Million Women Study (MWS) that were first published in 2002 and 2003. Since the publication of these studies, prescriptions of HT have markedly declined and there have been many media scares. An unfortunate sequel was an extrapolation of the observations from women in their 50s and older to those with early ovarian failure. This article discusses the WHI and the MWS with a focus on differences between HT regimens including doses, formulations, and routes, timing, and duration of HT. It addresses practical issues such as strategies for stopping HT, and discusses bioidentical hormones. The specialist knowledge now required to deliver post-reproductive health service has led to considerations that menopause management should be now the responsibility of a specialist and not a general gynecologist.

Introduction

Menopausal hormone therapy (HT) has been around for ~70 years and is thus a treatment modality about which we know a great deal more than for other highly used agents such as β-blockers that were introduced later. Levels of HT prescribing increased in the 1960s to the 1990s with the promotion of concepts "feminine forever" (as indeed a book was entitled)[1] and "estrogen forever." HT gained repute as a universal panacea for women's problems from midlife onward. This concept was challenged by two studies set up in the 1990s: the Women's Health Initiative (WHI) and the Million Women Study (MWS). Since the publication of these two studies, prescriptions of HT have declined and probably have been fine-tuned. However the findings of these studies undertaken in women ≥50 years have been extrapolated to all age groups, much to the detriment of those debilitated by menopausal symptoms and those experiencing early ovarian failure. This article discusses the WHI and the MWS, differences between regimens, timing and duration of treatment, and practical issues such as stopping HT, intrauterine progestogens, and bioidentical hormones.

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