As opinion leaders in the field of menopause medicine from various areas in the world, we wish to emphasize the following points concerning postmenopausal hormone therapy:
- Hormone therapy (HT) remains the most effective treatment for vasomotor symptoms and estrogen-deficient urogenital symptoms.
- The initial interpretation of the Women’s Health Initiative (WHI) trial failed to recognize the immense importance of age and years since menopause on outcomes of HT. The potential impact of specific hormonal regimens on safety of HT should be considered as well.
- The results of the WHI trial were wrongly extrapolated to the whole postmenopausal population, which led to a major change in recommendations and guidelines on HT.
- Based on current knowledge, the balance between the benefits and risks of HT is clearly in favor of use in the early postmenopausal years for symptomatic, healthy women.
- All previous studies, including the WHI trial, have demonstrated significant positive effect on bone density and reduction in fracture risk among hormone users.
- Estrogen has favorable metabolic and cardioprotective effects in healthy, young postmenopausal women. The results for the age group 50–59 years in the WHI estrogen-alone arm support this claim. Estrogen slows the pace of development of atherosclerosis if started in the early postmenopausal period.
- HT may be associated with a small increase in risk for breast cancer, if taken long term. Combined estrogen–progestogen therapy probably carries a higher risk than that recorded for estrogen alone. Prevalence of stroke and thromboembolism strongly correlates with age; therefore, the impact of the HT-related increased risk in this respect becomes more important in the late menopause. Low-dose estrogen or the transdermal route of administration may lead to a more favorable risk profile.
- Progestins, combined with estrogen, may decrease the magnitude of estrogen-related cardiac benefits, and increase the risk for breast cancer. There are insufficient data to evaluate the possible differences in the incidence of breast cancer using different types and routes of progestin administration.
Based on the above, we call upon the health authorities to review their policies and revise them in view of the new age-related data on HT. Also, the different outcomes of estrogen-alone and estrogen plus progestin therapy should be considered. Overall, the safety profile of HT until age 60 is favorable, and should not preclude women from using HT when appropriate. Issues of quality of life, including mental, emotional, cognitive and sexual function, should have a higher priority while discussing regulatory policies and official guidelines on postmenopausal HT use.
Professor Amos Pines, IMS President
Dr David W. Sturdee, IMS General Secretary, President-Elect
Professor Martin Birkhäuser, IMS Treasurer
Dr Alice MacLennan, Chairman of the Council of Affiliated Menopause Societies
This Plea has also been signed by members of the IMS Board, by many regional and national menopause societies, and by hundreds of individual doctors, clinicians and researchers from Belgium, Britain, Finland, The Netherlands, Portugal, Spain, France, Hungary, Austria, Czech Republic, Romania, Italy, Switzerland, Sweden, Germany, Lithuania, Macedonia, Turkey, Greece, Slovakia, South Africa, Israel, Egypt, Malta, Cuba, Costa Rica, Argentina, Bolivia, Peru, Mexico, Ecuador, Uruguay, Nicaragua, San Salvador, Colombia, Chile, Indonesia, Korea, Hong Kong, Taiwan, Malaysia, Japan, and the USA.