May 24, 2013---The British Menopause Society (BMS) and Women's Health Concern has issued updated guidelines on hormone replacement therapy (HRT) to clarify its use, benefits, and risks. The new recommendations, intended to complement the BMS Observations and Recommendations on menopause, were published online May 24 and in the June print issue of Menopause International.

"Our aim is to provide helpful and pragmatic guidelines for health professionals involved in prescribing HRT and for women considering or currently using HRT," lead author Nick Panay, BMS chair, said in a news release. "With these updated recommendations, it is hoped that HRT will once again be used appropriately and provide benefits for many women in their menopause."

When first introduced more than a decade ago, HRT was considered to be the "elixir of youth," but accumulating evidence has highlighted associated risks precluding widespread use. Findings from the Women's Health Initiative in 2002 and the Million Women study in 2003 made use of HRT controversial, despite the known benefits. The evidence base for the new guidelines includes a reanalysis of the Women's Health Initiative and Million Women study trials and additional studies.

The updated recommendations provide advice regarding optimizing the menopause transition and beyond, using lifestyle and dietary interventions, complementary therapies, and HRT.

Key Recommendations

• After receiving sufficient information from her health professional to make a fully informed choice, each woman should decide whether to use HRT.

• The clinician should individualize the HRT dosage, regimen, and duration and reassess risks and benefits annually.

• One of the main indications for HRT in postmenopausal women is relief of vasomotor symptoms, which are most effectively relieved by estrogen.

• If menopausal symptoms persist, the benefits of HRT usually outweigh the risks. Therefore, the duration of HRT usage should not be subject to arbitrary limits.

• When prescribed to women younger than 60 years, HRT has a favorable benefit/risk profile.

• Women with premature ovarian insufficiency must be encouraged to use HRT, at least until the average age of the menopause.

• If women older than 60 years opt for HRT, they should start with lower doses, preferably via the transdermal route.

• Routine management of all women in the menopause transition and beyond should include optimization of diet and lifestyle.

• Pharmacological alternatives to HRT may include selective serotonin reuptake inhibitors such as fluoxetine and paroxetine for vasomotor symptoms, venlafaxine, gabapentin, and possibly clonidine.

• Phytoestrogens offer some benefits for symptom relief and on the skeletal and cardiovascular systems.

"It is imperative that in our ageing population research and development of increasingly sophisticated hormonal preparations should continue to maximize benefits and minimise side effects and risks," the guidelines authors conclude.

"This will optimise quality of life and facilitate the primary prevention of long-term conditions which create a personal, social and economic burden."

By Laurie Barkley, MD
Menopause Int. Published online May 24, 2013.
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