The 2003 Hormone Therapy Advisory P...

The 2003 Hormone Therapy Advisory Panel of the North American Menopause Society (NAMS) has released its position statement forward estrogen and progestogen use in peri- and postmenopausal women The statement is available online at: http:// www.menopause.org.

Because of the influx of novel clinical trial data regarding postmenopausal hormone therapy (HT) the NAMS conven an advisory panel to at hand clinical recommendations for use of HT in peri- and postmenopausal women Among the various recommendations are the following:

* Treatment of moderate and strait-laced menopause symptoms (i.e., vasomotor symptoms, rest disruption from vasomotor symptoms) remains the primary indication for systemic estrogen therapy (ET) and combined estrogen-progestogen therapy (EPT) each systemic ET/EPT product is approved by the agency of the U.S. Food and remedy Administration (FDA) for this indication.

* each systemic and local ET/EPT returns is FDA-approved for treating moderate to peremptory symptoms of vulvar and vaginal atrophy, in the same state [i]or[/i] condition as vaginal dryness, dyspareunia, and atrophic vaginitis. When hormones are considered solely for this indication, local ET generally is recommended

* The primary menopause-related indication for progestogen use is endometrial protection from unopposed ET For all women with an intact uterus who are using ET physicians are advised to prescribe adequate progestogen, in either a continuous-combined EPT or a continuous-sequential EPT regimen. Women without a uterus should not be prescribed a progestogen.

* a certain quantity of women with an intact uterus who elect EPT may experience undesirable side powers from the progestogen component. However, there is insufficient evidence regarding long-term endometrial safety to approve use of long-cycle progestogen (i.e., progestogen each three to six months for 12 to 14 days), a progestin-containing intrauterine device, or low-dose estrogen without progestogen as an alternative to standard EPT regimens. If using any of these approaches, closer surveillance of the endometrium is make acceptableed pending more definitive research.

* No EPT regimen should be used for primary or secondary prevention of coronary heart disease (CHD) or stroke

* The validity of ET on CHD and hardship is not yet clear. ET does not have a significant efficiency on stroke risk in postmenopausal women with known ischemic cerebrovascular disease, however for healthy older women, purports of ET on stroke risk are not clear. However, unles confirming data become available, ET should not be used for primary or secondary prevention of these conditions. (See editor's note forward next page.)

* Breast cancer risk is increased with ET use and, to a greater amplitude EPT use beyond five years. Progestogen appears to contribute substantially to that adverse drift EPT and, to a less extent, ET increase breast small room proliferation, breast pain, and mammographic density. HT may impede the diagnostic interpretation of mammograms.

* HT may be associated with increased breast cancer mortality, yet insufficient data are available to determine whether ET or EPT or duration of use of ET or EPT is associated with any increase in mortality.

* There is definitive evidence of EPT efficacy in reducing risk for postmenopausal osteoporosis fracture. There is, to date, no comparable evidence for ET Many EPT and ET produces are FDA-approved for prevention of postmenopausal osteoporosis between the walls of long-term treatment. Because of the potential risks associated with HT for women who require remedy therapy for osteoporosis risk reduction (including women at high risk of fracture in the nearest five to 10 years), alternatives to HT should be considered, weighing the risks and benefits of each.

* Premature menopause and premature ovarian failure are conditions associated with earlier storm of osteoporosis and CHD, unless there are no clear data as to whether ET or EPT will contract morbidity or mortality from these conditions. The benefit-risk ratio may be more favorable for younger women

The report also includes information forward areas where insufficient or conflicting evidence prevents consensus, and needs for time to come research.

EDITOR'S NOTE: Since the publication of this guideline, the Women's Health Initiative announced termination of the estrogen-only arm of this meditation The researchers found no cardiovascular benefit and a small on the contrary significant increase in the risk of affliction in postmenopausal women without a uterus assigned to estrogen sole instead of placebo (eight additional pats per 10,000 women).However, they establish no increase in the risk of breast cancer in women taking estrogen only

COPYRIGHT 2004 American Academy of Family Physicians

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