COMMENTARY

Treating Menopause: Are We Going Loco?

Charles P. Vega, MD

Disclosures

August 06, 2013

In This Article

The New Recommendations on Hormone Therapy

The new recommendations from the British Menopause Society and Women's Health Concern, however, appear to push the indication for disease prevention back toward 1999. The recommendations correctly describe how hormone therapy is the most effective treatment for vasomotor symptoms, and observational data demonstrate that it can improve mood as well (more on this below).

But the guidelines go well beyond these solid data to embrace the preventive potential of hormone therapy. They claim that it is the first-line treatment for osteoporosis among women younger than age 60 years, despite the fact that bone mineral density declines rapidly after the cessation of hormone therapy.[7] This phenomenon does not occur with alendronate.

The guidelines also describe the positive effects of hormone therapy on cognition, seen in data from observational trials. Because the authors also note that WHI failed to demonstrate any cognitive benefit associated with hormone therapy and that hormones should not be used solely to improve cognition, why even consider this point, especially given more recent data from randomized trials which found that younger women, who were considered to potentially occupy a critical window for a preventive intervention, gained no cognitive advantage from 7 years of hormone therapy?[8]

It is clear that we have pulled too far back when it comes to the use of hormone therapy. Millions of women do not need to suffer with debilitating symptoms. But, of all drugs, we should be very careful in promoting hormone therapy as a means to prevent disease. Given the all-too-familiar history of these drugs, any change in the prescribing indication should be remarkably evidence-based.

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