Estrogen and progestogen use in postmenopausal women: 2010 position statement of The North American Menopause Society

@article{Richard2010EstrogenAP,
  title={Estrogen and progestogen use in postmenopausal women: 2010 position statement of The North American Menopause Society},
  author={Jessica Richard and Santen},
  journal={Menopause},
  year={2010},
  volume={17},
  pages={242-255}
}
Objective: To update for both clinicians and the lay public the evidence-based position statement published by The North American Menopause Society (NAMS) in July 2008 regarding its recommendations for menopausal hormone therapy (HT) for postmenopausal women, with consideration for the therapeutic benefit-risk ratio at various times through menopause and beyond. Methods: An Advisory Panel of clinicians and researchers expert in the field of women's health was enlisted to review the July 2008… 
On the need to clarify and disseminate contemporary knowledge of hormone therapy initiated near menopause
  • R. Langer
  • Medicine
    Climacteric : the journal of the International Menopause Society
  • 2010
TLDR
Findings in the limited numbers of younger menopausal women in the WHI CEE + MPA trial, and findings in the CEE-only trial, suggest that age at initiating HT strongly influences outcomes, and that benefits greatly exceed risk for most women who start within 10 years of menopause.
Update: Estrogen and Estrogen plus Progestin Therapy in the Care of Women at and after the Menopause
TLDR
A simplified approach to MHT is suggested as a framework for the care of women at and after the menopause, which is by far the most effective treatment, and greatly improves the quality of life in women with menopausal symptoms.
MENOPAUSE: AN OVERVIEW OF CURRENT ASSESSMENT AND MANAGEMENT
There has been a marked decline in hormonal therapy (HT) for menopausal symptoms, since 2002, due the understanding of the benefits and risks as described in the Women’s Health Initiative (WHI).
Updated IMS recommendations on postmenopausal hormone therapy and preventive strategies for midlife health
  • D. Sturdee, A. Pines
  • Medicine
    Climacteric : the journal of the International Menopause Society
  • 2011
TLDR
The pendulum swung back from its peak negative sentiment following more detailed data from the WHI study that demonstrated the importance of the age at initiation and the good safety profile of HRT in women younger than 60 years.
Hormone Therapy for the Management of Menopausal Symptoms
TLDR
HT may be a reasonable pharmacotherapy option for the management of menopausal symptoms following complete patient evaluation by experienced clinicians and Updated recommendations addressing management ofMenopausal symptoms, a new HT product containing the spironolactone-analogue drospirenone (DRSP), and discontinuation methods of HT are discussed.
An update on menopausal hormone replacement therapy in women and cardiovascular disease
TLDR
Evidence is accumulating that careful use of MHT for perimenopausal symptoms may not carry CVD harm, and use of selective estrogen receptor modulator for primary prevention of CVD is not supported.
Trends in menopausal hormone therapy use of US office-based physicians, 2000-2009
TLDR
Uptake of these products, however, has been modest, and substantial use of MHT continues in older women, as increased use of lower dose and vaginal products reflects clinical recommendations.
Menopausal Hormone Therapy (MHT)
TLDR
Ongoing research in women younger than those in prior trials is evaluating lower doses of MHT and directly comparing transdermal and oral formulations, which should help define the population of women most likely to benefit from MHT without undue risk of adverse outcomes.
Premature menopause or early menopause and risk of ischemic stroke
TLDR
It is hypothesized that estrogen is protective for ischemic stroke before age 50 years and may become a risk factor for IS after age50 years or, possibly, after age 60 years.
Use of hormone therapy by female gynecologists and female partners of male gynecologists in Germany 8 years after the Women’s Health Initiative study: results of a survey
TLDR
It is demonstrated that although the great majority of German gynecologists have a favorable attitude regarding personal use of HT, various discrepancies between physician and patient care exist, especially for the indications of cognitive disorders, achievement of overall well-being, and antiaging.
...
1
2
3
4
5
...

References

SHOWING 1-10 OF 92 REFERENCES
Management of osteoporosis in postmenopausal women: 2010 position statement of The North American Menopause Society
TLDR
Management strategies for postmenopausal women involve identifying those at risk for fracture, followed by instituting measures that focus on reducing modifiable risk factors through dietary and lifestyle changes and, if indicated, pharmacologic therapy.
Estrogen plus progestin therapy and breast cancer in recently postmenopausal women.
TLDR
Combined trial and observational study data support an adverse effect on breast cancer risk, and women who initiate use soon after menopause, and continue for many years, appear to be at particularly high risk.
Conjugated equine estrogens and breast cancer risk in the Women's Health Initiative clinical trial and observational study.
TLDR
For women who begin use soon after menopause, combined analyses of clinical trial and observational study data do not provide clear evidence of either an overall reduction or an increase in breast cancer risk with CEEs, although hazard ratios appeared to be relatively higher among women having certain breast cancerrisk factors or a low body mass index.
Benefits and risks of postmenopausal hormone therapy when it is initiated soon after menopause.
TLDR
Estrogen plus progestin results among women who initiated use soon after menopause were similar for venous thromboembolism, stroke, and hip fracture but also included evidence of longer-term elevations in breast cancer, total cancer, and the global index.
Breast cancer after use of estrogen plus progestin in postmenopausal women.
TLDR
The increased risk of breast cancer associated with the use of estrogen plus progestin declined markedly soon after discontinuation of combined hormone therapy and was unrelated to changes in frequency of mammography.
Postmenopausal hormone therapy and stroke: role of time since menopause and age at initiation of hormone therapy.
TLDR
Hormone therapy is associated with an increased risk of stroke, and this increased risk does not appear to be related to the timing of the initiation of HT, in younger women, with lower stroke risk.
Endometrial Cancer in Postmenopausal Women Using Estradiol–Progestin Therapy
TLDR
Use of a continuous rather than a sequential estradiol–progestin regimen decreases the risk of endometrial cancer, whereas the route of administration or type of progestin does not differ in terms of endometricrial cancer risk.
Coronary heart disease and menopause management: the swinging pendulum of HRT.
TLDR
A major difference in the effects of hormones between younger and older women has emerged but this important finding has been minimized, and the final findings for all outcomes closely resemble those from observational cohorts.
Menopausal Hormone Therapy and Risk of Epithelial Ovarian Cancer
TLDR
The progestogen component of HT may confer a risk reduction that is masked by an opposing effect of estrogen until, among former users, estrogenic influences have diminished, and may have implications both for public health and development of chemoprevention strategies.
Conjugated Equine Estrogens and Colorectal Cancer Incidence and Survival: The Women's Health Initiative Randomized Clinical Trial
TLDR
In contrast to the preponderance of observational studies, conjugated equine estrogens in a randomized clinical trial did not reduce colorectal cancer incidence nor improve survival after diagnosis.
...
1
2
3
4
5
...