In a new report released in June at the World Congress of Menopause in Rome, the International Menopause Society updated the HRT guidelines with a new position statement indicating that HRT treatment should be evaluated and considered on an individual basis.
The recommendations may help to settle the controversy that arose in 2002 following a report from the Women’s Health Initiative (WHI). That study, which began as a prevention trial for heart disease, concluded that HRT did not protect the heart and that its risks outweighed the benefits for preventing chronic disease. But when the menopause society’s writing group reviewed the WHI and additional evidence, they concluded HRT is generally safe for most women at the time of menopause. One reason for the reversal is that the average age of the participants in the earlier study was 63, which is typically after menopausal symptoms end, and an unusual time to start hormone replacement.
Some key points from the new IMS findings include:
Consideration of HRT should be part of an overall strategy including lifestyle recommendations regarding diet, exercise, smoking cessation and safe levels of alcohol consumption for maintaining the health of peri- and postmenopausal women.
There is evidence that estrogen therapy may be cardioprotective if started around the time of menopause and continued long term (often referred to as the ‘window of opportunity’ concept). HRT has the potential for improving the cardiovascular risk profile through its beneficial effects on vascular function, cholesterol levels, glucose metabolism and blood pressure.
The IMS’s new recommendations indicate that HRT reduces the risk of diabetes and through improving insulin action in women with insulin resistance, has positive effects on other related risk factors for cardiovascular disease (such as metabolic syndrome).
Randomized controlled data from the WHI study demonstrated no increased risk in first-time users of combined HRT during the 5–7 years since initiation of treatment. Data from the WHI and the Nurses’ Health Study suggest that long-term, estrogen-only administration for seven and 15 years, respectively, does not increase the risk of breast cancer in North American women.
The incidence of breast cancer varies in different countries. Therefore, currently available data may not be applicable everywhere. The degree of association between breast cancer and postmenopausal HRT remains controversial.
Women should be reassured that the possible increased risks of breast cancer associated with HRT are small (an incidence of < 1.0 per 1000 women per year of use), and less than the increased risks associated with common lifestyle factors such as obesity and alcohol consumption.
At Cenegenics Carolinas, we’ve known for years that HRT must be individualized and tailored according to symptoms and the need for prevention, as well as personal and family history, results of relevant investigations, the woman’s preferences and expectations. Each patient receiving HRT (or bioidentical hormone replacement therapy, or BHRT) is evaluated thoroughly and on a regular basis as symptoms and needs change.
In my practice, hormone therapy is part of a comprehensive program tailored to each woman’s individual health, symptoms, and test results. We’ve been using personalized bioidentical hormone optimization since it became available, along with fitness and nutritional recommendations, including supplements like fish oil to reduce platelet stickiness (which causes clogged arteries and increases risk of heart attack and stroke). This type of individualized treatment is safer than the standard estrogen-plus-progestin combinations that doctors have been prescribing to menopausal women for years. We continuously measure and monitor free hormone levels and prescribe accordingly—meaning no guess work for our patients.
It’s time for women to stop responding with fear to differing opinions and “medical expertise” offered up by various sources. Each woman is different and her health plan, hormone needs and treatments should be comprehensive and individualized.
If you’re located in Charleston or surrounding areas, you can find out more about bioidentical hormone replacement therapy on our web site here or by contacting our offices at 843-577-8484.