HRT reanalyses shows favorable risk-benefit profile with recommended treatment strategies

The risk-benefit ratio is in favor of hormone replacement therapy (HRT) when initiated near menopause, according to new consensus statements issued by The North American Menopause Society, The American Menopause Society, and the International Menopause Society and published in a recent paper in the July issue of Women’s Health.

A reanalyses of over 40 years of scientific studies has demonstrated that estrogen is a medication that can decrease mortality, cardiovascular disease, osteoporosis fracture, urogenital atrophy, and dementia. It is associated with low risks and significant benefits when factors such as timing of administration, dosing, and route of administration are considered.

Specific strategies to consider for women who would like the benefits associated with HRT, include:

• beginning therapy in women under aged 60 years or within 10 years of menopause onset; studies support a possible cardiovascular protective benefit of HRT.

• using the lowest effective dose for menopausal symptoms may lower the risk of side effects;

• using non-oral delivery methods to minimize the effect of estrogen on hepatic proteins;

• adding a progestin for women with a uterus to protect the endometrium from overstimulation;

• considering high-risk patients and fully evaluating a risk-benefit profile before initiating hormone therapy.

Over the next 5 years, results of both the Early Versus Late Intervention Trial With Estradiol (ELITE) and Kronos Early Estrogen Prevention Study (KEEPS) trial will become available, which are expected to further clarify the cardiovascular protective effects of estrogen replacement when given to women in their early menopause years compared with those that have 10 years or more of menopause, the authors note.

“It is also expected that new low-dose estrogen only and combination products with new progestins will be introduced that will increase the choices for the large numbers of women entering the menopause,” the authors wrote.