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An international group of menopause experts has concluded that HRT in the early postmenopausal period is safe, and healthy women going through the first few years of menopause who need HRT to relieve symptoms should have no fears about its use
This is the conclusion and clinical advice of the First Global Summit on Menopause-Related Issues, which was held in Zuerich on 29 and 30 March.
The Zuerich Summit was attended by global experts in menopause and related issues. It reviewed the evidence on the safety, risks and benefits of HRT in the first few years of the menopause, looking at four main areas of controversy: cardiovascular health, breast issues, cognition, and bone issues.
Summit members compared public perception with actual safety, and are now issuing a state-of-the-science summary, to enable women and clinicians to make informed judgements about whether or not to use HRT in early menopause.
Professor Amos Pines, President of the International Menopause Society, will present the Summit findings at the World Congress on the Menopause in Madrid on 20 May.
Hormone replacement therapy (HRT) use declined after the Women’s Health Initiative (WHI) study results were published in 2002.
Initial results from the WHI study seemed to show that women taking HRT were at greater risk of breast cancer and heart disease, and this study had a dramatic effect on public perceptions and confidence in the use of HRT.
However, since the first WHI information was released, it has become apparent that the study group was not completely representative of women taking HRT, and was characterized by a high incidence of several important risk factors, unusual in younger women around their menopause. For example, the average age of women in the WHI study was 63 years of age, which is a decade older than the age at which most women begin taking HRT, and of women randomly assigned in the WHI study, 36% had hypertension, 49% were current or past smokers, and 34% were clinically obese, which are all factors which would contribute to increased health problems.
In addition, the reporting of the study did not make clear that different HRTs have different risks and benefits, but most importantly the most recent reports from WHI have clearly shown that the age at which HRT is started is critical.
Most experts now agree that the fall-out from the initial WHI results has led to public concern about HRT use, which is not justified by the clinical evidence.
Dr Roger Lobo (Columbia University, New York), who was one of the US clinicians attending the Zurich Summit, said: “Each woman is an individual, and it’s important that she comes to an agreement with her doctor about using HRT. But the take-home message from this important summit is that for young healthy women at the onset of menopause, there is very little risk and the benefits outweigh the risks for women with symptoms.”