Menopausal Hormone Therapy is the New HRT Part 2

Yesterday, I noted the first 4 global consensus statements regarding our current knowledge & view of menopausal hormone treatment (MHT), formerly known as hormone replacement therapy (HRT), aka estrogen replacement therapy (ERT).  For a quick refresher, let's remember that these recommendations only apply to women <60yo and/or <10yrs post-menopause.  With that in mind . . .

5) Estrogen alone is appropriate after hysterectomy but additional progestogen must be used if uterus present (nothing new here);

6) MHT is a personal decision that needs to balance risk vs benefit (nothing new here either);

7) MHT increases risk of clotting problems eg deep vein thrombosis & ischemic stroke, but absolute risk remains low if <60yo; observational study suggests transdermal MHT is associated w/even lower risk of clotting issue (which is why I've been advocating creams or patches rather than pills);

8) Increased risk of breast cancer is associated w/progestogen use & related to duration of use; as w/DVT & stroke, absolute risk is low & decreases after MHT is stopped.

This last point is one of vindication for me & many others as we thought it odd that while the E+P arm of Women's Health Initiative was linked to breast cancer & the E only arm wasn't, all the blame for breast cancer was laid at the feet of E.

And yet we see this same rush to judg(e)ment with the recent HPS2-THRIVE study in which niacin+laropiprant was compared to placebo rather than to niacin and yet niacin was blamed for the bad outcome, rather than positing that perhaps this novel agent, laropiprant was the cause.  Don't get me wrong.  I'm not saying that niacin is a great drug but rather that we can't blame it alone for bad outcomes when the study didn't compare it alone to placebo, but rather it in combination w/an unknown drug to placebo.

Stay tuned for Part 3 of this look at the Global Consensus Statement on menopausal hormone therapy.

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