Individualizing Hormone Therapy to Minimize Risk

Accurate Assessment of Risks and Benefits

Donna Shoupe

Disclosures

Women's Health. 2011;7(4):475-485. 

In This Article

Summary for Individualizing Hormone Therapy: Start With an Accurate Analysis of the Risks & Benefits

Contrary to the 2002 media-driven hype surrounding the initial presentation of the WHI, there are new, better considered and much more reassuring consensus statements on HRT. The new consensus statements on HRT are based both on reanalyses of published data from the WHI and on other extensive studies that must be included in an accurate risk–benefits analyses of HRT. The North American Menopause Society, The American Menopause Society and the International Menopause Society now concur that the risk–benefit ratio is in favor of HRT when initiated near menopause.

Estrogen is a medication that is reported to decrease overall mortality, cardiovascular disease, decrease osteoporosis fracture, urogenital atrophy and dementia. When timing of administration, dose of therapy and route of administration are considered, estrogen is associated with low risks. The decision to take or to recommend low-dose estrogen therapy for either short or long term, should include an accurate risk–benefit analysis:

  • Estrogen/hormone therapy is FDA-approved for the prevention of bone loss and urogenital atrophy and is approved as a treatment of menopausal symptoms. Multiple other studies support the protective effect of estrogen therapy on cardiovascular disease, dementia and overall mortality. Data suggests that hormone therapy is singularly effective in preventing cardiovascular disease for women when therapy is started within 10 years of their menopause;

  • The risks associated with low-dose estrogen/hormone therapy are very low if started within 10 years of menopause or under 60 years of age;

  • Women with cardiovascular or thrombotic risk factors, those initiating therapy after age 60 or >10 years since menopause, or those with significant obesity should consider low-dose transdermal estrogen/hormone therapy;

  • Initiation of hormone therapy for treatment of menopausal symptoms in early menopause or perimenopause is associated with low risk. Decisions regarding long-term use of hormone therapy should be based on an accurate risk–benefit analysis.

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