HRT safe for healthy women entering menopause

May 20 2008

HRT in the early postmenopausal period is safe, and healthy women going through the first few years of the menopause who need HRT to relieve symptoms should have no fears about its use. This is the conclusion and clinical advice of the First Global Summit on Menopause-Related Issues, which was held in Zürich on March 29th and 30th, 2008.

The Zürich Summit was attended by global experts in menopause and related issues. It reviewed the evidence on the safety, risks and benefits of HRT in the first few years of the menopause, looking at 4 main areas of controversy: cardiovascular health, breast issues, cognition, and bone issues. Summit members compared public perception with actual safety, and are now issuing a state-of-the science summary, to enable women and clinicians to make informed judgements about whether or not to use HRT in early menopause.

Professor Amos Pines, President of the International Menopause Society, will present the Summit findings at the World Congress on the Menopause in Madrid on 20th May.

Background - the WHI Study

Hormone replacement therapy (HRT) use declined after the Women's Health Initiative (WHI) study results were published in 2002. Initial results from the WHI study seemed to show that women taking HRT were at greater risk of breast cancer and heart disease, and this study had a dramatic effect on public perceptions and confidence in the use of HRT. However, since the first WHI information was released, it has become apparent that the study group was not completely representative of women taking HRT, and was characterized by a high incidence of several important risk factors, unusual in younger women around their menopause. For example:

The average age of women in the WHI study was 63 years of age, which is a decade older than the age at which most women begin taking HRT

Of women randomly assigned in the WHI study, 36% had hypertension, 49% were current or past smokers, and 34% were clinically obese, which are all factors which would contribute to increased health problems.

In addition, the reporting of the study did not make clear that different HRTs have different risks and benefits, but most importantly the most recent reports from WHI have clearly shown that the age at which HRT is started is critical. Most experts now agree that the fall-out from the initial WHI results has led to public concern about HRT use, which is not justified by the clinical evidence.

The Zürich Summit

The Zürich Summit was called to review the current evidence, and to review the risks and benefits of using HRT for women in early menopause. Forty of the world's leading menopause experts met to review public perceptions, risks and benefits. Their main conclusions were:

Cardiovascular issues

Combined oestrogen and progesterone do not increase chronic heart disease risk in healthy women aged 50-59; oestrogen alone actually decreases risk in this group.

Breast cancer

Certain types of HRT (combined oestrogen and progesterone) can lead to a slightly increased risk of breast cancer. However, this is minimal in relation to other breast cancer risk factors. Women with no prior use of estrogen alone actually had no increased risk for breast cancer in the WHI. Short-to-medium term use of oestrogen-only HRT does not show this effect. The key message is that each woman should discuss her general health, and risk factors such as a family history, smoking, etc., with her own doctor, but generally healthy women (i.e. with no other breast cancer risk factors) entering the menopause should have no fears.

Bone

HRT is effective in maintaining bone health in 50 to 59-year-old postmenopausal women.

Cognition

HRT does not impair cognition in healthy women aged 50-59, and may even delay the decrease of cognitive functions in this group.

Presenting the data at the Madrid Menopause congress, International Menopause Society President Professor Amos Pines (Tel-Aviv, Israel) said:

This is positive news about HRT in the early menopause years, between the ages of 50 and 59. The Zürich Summit is the most important menopause workshop to discuss this issue, and it would be hard to find a more distinguished group of experts in the field. Their conclusions are that, for most women entering the menopause, HRT is a good and safe option. Of course, each woman is an individual, and HRT use should be decided after discussions with her doctor.

Dr Roger Lobo (Columbia University, New York), who was one of the US clinicians attending the Zurich Summit, said

Each woman is an individual, and it's important that she comes to an agreement with her doctor about using HRT. But the take-home message from this important summit is that for young healthy women at the onset of menopause, there is very little risk and the benefits outweigh the risks for women with symptoms.

The work of this international summit reinforces the findings of other bodies working in the field. As new data has emerged over the last few years, and as the original data has been re-examined, several bodies in the US, such as the American Association of Clinical Endocrinologists, and the North American Menopause Society, have also come to similar conclusions. This summit provides the global agreement on these views.