Benefits of HT Outweigh Risks for Most Menopausal Women

Andrew M. Kaunitz, MD


September 10, 2015

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Hello. I'm Andrew Kaunitz, professor and associate chairman of the obstetrics and gynecology department at the University of Florida College of Medicine in Jacksonville. Today I would like to discuss a new review article that addresses treatment of menopausal symptoms.

In the October issue of the American College of Obstetricians and Gynecologists' Green Journal, my colleague Dr JoAnn Manson and I provide an update on the management of menopausal symptoms.[1] Our review details treatments such as:

  • oral and transdermal hormone therapy (HT);

  • oral equine estrogen combined with the selective estrogen receptor modulator bazedoxifene;

  • compounded bioidentical HT;

  • over-the-counter supplements such as soy and black cohosh;

  • prescription nonhormonal medications such as paroxetine mesylate, venlafaxine, and gabapentin;

  • low-dose vaginal estrogen; and

  • ospemifene.

We also review challenging management scenarios, including:

  • treatment of women with early menopause;

  • extended-duration use of HT;

  • HT use in women who carry BRCA mutations or who have a personal history of breast cancer; and

  • systemic estrogen-only therapy in women with an intact uterus.

With respect to the safety of HT, the initial publication[2] of findings from the Women's Health Initiative (WHI) estrogen-progestin therapy trial in 2002 led to a marked drop in the use of HT among US women. In our review, we focus on 13-year, long-term follow-up of WHI participants and conclude that, for most recently menopausal women with bothersome vasomotor symptoms, benefits of HT outweigh the risks.

In addition to highlighting the safety of initiating HT in younger vs older menopausal women, we point out that estrogen-only therapy has a benefit-to-risk profile that is more favorable than that of estrogen-progestin therapy.

I hope you will also have the opportunity to view Dr Manson's Medscape video on our review. Most important, we both hope that this article will convey information that ultimately helps our menopausal patients make sound decisions regarding symptom management. Thank you. I'm Andrew Kaunitz.


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