Menopausal Hormone Therapy: Clear as Mud (Part 2)

So what did you think of yesterday's post regarding the latest analysis of the Women's Health Initiative?  Confusing, right?  Some benefit, but definitely some risk, too.  Of course, it appears that starting earlier is better than taking it later on.  Well, coincidentally, a population-based case-control study was published at the beginning of this week in JAMA Internal Medicine in which the authors concluded that oral conjugated equine estrogen (CEE) use was linked to greater risk for clotting & heart attack compared to plain estradiol (E2).

If you compare the above findings to the Global Consensus Statement on Menopausal Hormone Therapy published in March as well as the American College of Obstetricians and Gynecologists' Committee Opinion #556 published in April, you'll find that transdermal estradiol has an even lower risk of clots compared to any oral estrogen, but especially when mixed w/medroxyprogesterone acetate (MPA) as compared to plain progesterone.

For now, if you need MHT for unbearable menopausal symptoms, and not just for disease prevention, it would appear that you should try some form of transdermal E2 first.  And only if that doesn't work should you try an oral E2, leaving oral CEE as your hormone of last resort.  And if you have your female parts still in place (in other words, you haven't had a hysterectomy), ask for progesterone while avoiding medroxyprogesterone acetate.  I'm sure there'll be more updates to come in the future.  The final nail hasn't been hammered in yet!

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