Postmenopausal hormonal therapy

Menopause is the permanent cessation of menses following the loss of ovarian follicular activity. Perimenopause is the period immediately prior to the menopause and the first year after menopause. Indications of postmenopausal hormone therapy include the short-term treatment of menopausal symptoms (i.e., hot flushes, night sweats, and urogenital atrophy). 

Common Combination Postmenopausal Hormone Therapy Regimens... 

The American Heart Association recommends against postmenopausal hormone therapy for reducing the risk of coronary heart disease. 

Davison S, Davis SR (2003) New markers for cardiovascular disease risk in women impact of endogenous estrogen status and exogenous postmenopausal hormone therapy. J Clin Endocrinol Metab 88 2470-2478... 

Grodstein F, Stampfer MJ, Colditz GA, Willett WC, Manson JE, Joffe M, Rosner B, Fuchs C, Hankinson SE, Hunter DJ, Hennekens CH, Speizer FE. Postmenopausal hormone therapy and mortality. N Engl J Med 1997 336(25) 1769-75. 

Newcomer LM, Newcomb PA, Potter JD, Yasui Y, Trentham-Dietz A, Storer BE, Longnecker MP, Baron JA, Daling JR. Postmenopausal hormone therapy and risk of breast cancer by histologic type (United States). Cancer Causes Control 2003 14 225-33. 

Michels KB, Manson JE. Postmenopausal hormone therapy a reversal of fortune. Circulation 2003 107 1830-3. 

Grady D Postmenopausal hormones—therapy for symptoms only. New Engl J Med 2003 348 1835-7. 

Hersh AL, Stefanick ML, Stafford RS. National use of postmenopausal hormone therapy annual trends and response to recent evidence. JAMA 2004 291 47-53. 

Heckbert SR, Kaplan RC, Weiss NS, Psaty BM, Lin D, Furberg CD, Starr JR, Anderson GD, LaCroix AZ. Risk of recurrent coronary events in relation to use and recent initiation of postmenopausal hormone therapy. Arch Intern Med 2001 161(14) 1709-13. 

Cicinelli E, de Ziegler D, Alfonso R, et al. Endometrial effects, bleeding control, and compliance with a new postmenopausal hormone therapy regimen based on transdermal estradiol gel and every-other-day vaginal progesterone in capsules a 3-year pilot study. Fertil Steril. 2005 83 1859-1863. 

The most frequent uses of estrogens are for contraception (see p. 268), for postmenopausal hormone therapy and for osteoporosis. Estrogens are also used extensively for replacement therapy in patients deficient in this hormone. Such a deficiency can be due to lack of development of the ovaries, menopause, or castration. 

Estrogen-based postmenopausal hormone therapy should be used for the treatment of menopausal symptoms (i.e., vasomotor and urogenital symptoms) and, when specifically indicated, for osteoporosis prevention. 

The major indication for estrogen-containing hormone therapy is the relief of menopausal symptoms, and the benefits of short-term perimenopausal and postmenopausal hormone therapy for the relief of severe menopausal symptoms outweigh the risks in many women. 

Evaluation of each individual woman is essential in determining the appropriateness of perimenopausal and postmenopausal hormone therapy, and collaboration between a woman and her primary care provider in the decision-making process is essential. The benefits and risks of hormone therapy should be reassessed annually. 

Prior to publication of the WHI results, about 38% of postmenopausal women in the United States took hormone therapy. Approved indications of postmenopausal hormone therapy include... 

Postmenopausal hormone therapy is a subject of major interest in the field of women s health. Treatment of menopausal symptoms can be managed effectively in some women with lifestyle modifications, including exercise, weight control, smoking cessation, and a healthful diet. More recently, however, dietary supplements and nonpharma-cologic therapies have been promoted as complementary medicine alternatives to hormone therapy. To date, there is little to support the use of such nonprescription products, which include various herbal remedies and soy-based supplements. 

Vasomotor Symptoms. The major indication for postmenopausal hormone therapy is the management of vasomotor symptoms. Most women with vasomotor symptoms require hormone treatment for less than 5 years, and thus the risk appears to be small. 

TABLE 80—8. Randomized Clinical Trials of Cardiovascular Disease and Postmenopausal Hormone Therapy... 

TABLE 80—9. Randomized Clinical Trials of Postmenopausal Hormone Therapy and Breast Cancer... 

Estrogens and progestagens used for postmenopausal hormone therapy still are prescribed commonly in the United States, especially for the management of menopausal vasomotor symptoms. Even before pnblication of the WHI findings, only a fraction of women filled then-hormone therapy prescriptions, and only 25% to 40% continned to take postmenopausal hormone therapy for more than 1 year." This may be due to women s attitudes toward hormone therapy or aresnlt of fear about adverse effects and associated risks. Hormone therapy nse in the United States declined substantially after dissemination of the WHI study results." "... 

During the past decade, postmenopausal hormone therapy became one of the most frequently prescribed therapies in the United States. Menopause is a natural life event, not a disease. Therefore, the decision to use hormone therapy must be individualized based on the severity of menopausal symptoms, risk of osteoporosis, and consideration of such factors as coronary artery disease, breast cancer, and thromboembolism. 

Espeland MA, Hogan PE, Fineberg SE, et al. for the PEPI investigators. Effect of postmenopausal hormone therapy on glucose and insulin concentrations. Diabetes Care 1998 21 1589-1595. 

Kanaya AM, Herrington D, Vittinghoff E, et al. Glycemic effects of postmenopausal hormone therapy The Heart and Estrogen/Progestin Replacement Study. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 2003 138 1-9. 

Grodstein F, Manson JE, Colditz GA, et al. A prospective observational study of postmenopausal hormone therapy and primary prevention of cardiovascular disease. Ann Intern Med 2000 133 933-941. 

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