Menopausal Hormone Therapy is the New HRT

Time heals all wounds.  Prior to 2002's Women's Health Initiative, physicians advocated putting estrogen & progestins in the water or so it seemed, when it came to treating menopausal women suffering from vasomotor instability.  Our recommendations were based upon multiple observational studies which suggest preventive benefits as well as symptomatic relief.  But as you know by now, our world as we then knew it, came crashing down upon us.  And it typical reactive fashion, we threw the baby out with the bath water, moving 180o in the opposite direction, stating that anyone offering estrogen & progestin to any female was out of his/her mind, even though this randomized controlled trial was based upon asymptomatic women 10yrs post-menopause and thus not at all like our typical demographic.

Well, 11 years have passed since that fateful publication.  I'd like to think that we're wiser these days in discerning the difference between observational studies & RCTs but I'm afraid the lay press only works w/attention grabbing sound bites.  Be that as it may, the Endocrine Society, the North American Menopause Society, and several other international academic groups came together recently to hash out a Global Consensus Statement on menopausal hormone therapy published in the April issue of Maturitas.

1) MHT is useful against vasomotor symptoms w/benefits outweighing risks for those <60yo or <10yrs post-menopause;
2) MHT is useful in preventing osteoporosis-related fractures in those <60yo  or <10yrs post-menopause;
3) RCTs, observational studies & meta-analyses suggest that standard dose estrogen-only may decrease heart disease & death from any cause in those <60yo  or <10yrs post-menopause;
4) Localized estrogen is recommended if symptoms are just vaginal dryness and/or dyspareunia.

More statements to come tomorrow but notice that the 1st three are focused on those women <60yo or <10yrs post-menopause;

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