Hormone therapy has value to relieve menopause symptoms

But U.S. Preventative Services Task Force does not recommend hormones for chronic disease, contributing to doctors' confusion.

Menopausal hormonal therapy (MHT) remains the most effective treatment for moderate to severe hot flashes, which are often associated with sleep disturbances and mood changes, notes Dr. Susan Reed, an OB-GYN with the University of Washington School of Medicine and a specialist in treating hot flashes and other menopausal symptoms.

For the last 20 years, however, Reed and other clinicians who treat menopausal symptoms have had to fence with recommendations from the U.S. Preventive Services Task Force (USPSTF), a body that provides guidance for medication use with such chronic disease conditions as osteoporosis, heart disease, dementia and diabetes. 

At face value, the USPSTF's recommendations on menopause care, published most recently Nov. 1 (and five times overall since 2002), might appear to contradict the use of MHT to treat symptoms that most women experience between ages 50 and 60.  What the recommendations actually say, according to Reed, is that MHT ought not to be used to treat chronic conditions because the risks outweigh the benefits for most women over 60. 

Many clinicians and patients have interpreted the USPSTF as indicating that MHT should never be used, even with bothersome symptoms like moderate to severe hot flashes, sleep and mood disturbances, said Reed, who is also president of the North American Menopause Society.  “Physicians and their patients have stopped using MHT because they are afraid,” she said.

The task force's latest recommendation has more nuanced language than past guidance, Reed suggested; for example, it identifies the benefit of MHT for osteoporosis and diabetes prevention. Therefore, if a patient is having moderate to severe hot flashes and is also at risk for osteoporosis or diabetes, the appropriate treatment is MHT, hands-down, so long as no contraindications exist to hormone therapy, Reed said.

Hopefully the updated language will encourage patients and clinicians to engage in shared decision-making, she said.

“All women with symptoms at menopause deserve a discussion of risks and benefits of hormonal and nonhormonal therapies to treat menopausal symptoms following a careful and thorough discussion of individual risks and benefits given medical and family history."

Barbara Clements, 253-740-5043, bac60@uw.edu. 

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