HRT safe and viable as short-term treatment for menopausal symptoms: SOGC
Reported January 23, 2009
TORONTO Hormone replacement therapy is a safe and viable option for the short-term treatment of symptoms of menopause, the Society of Obstetricians and Gynaecologists of Canada said Thursday in guidance designed to calm what the group called “unfounded” fears about HRT.
In updated advice to doctors, the society said results of a landmark U.S. study published in 2002 had scared off women suffering with the symptoms of menopause, leading them to reject a therapy that can safely treat their hot flashes, night sweats, mood swings and sleep disturbances.
“The message we need to get out is that it’s a safe option to consider, when you’re looking at all of your options. And I think it shouldn’t be taken off the table summarily,” said Dr. Robert Reid, lead author on the updated guidance and chair of the division of reproductive endocrinology and infertility at Queen’s University, in Kingston, Ont.
“We think women deserve better advice and care than they have been receiving since the Women’s Health Initiative.”
The Women’s Health Initiative was a large U.S.-government funded randomized controlled trial designed to see whether HRT lowered a woman’s risk of cardiovascular disease. It compared post-menopausal women who were on hormone replacement to women who received a placebo instead.
The study was stopped early when it was found women on HRT had a slightly elevated rate of heart attack and stroke than those who weren’t taking the drugs. Those heart disease risks were in addition to a previously known increase risk of breast cancer.
Interestingly, the numbers of newly diagnosed breast cancers fell substantially in both the U.S. and Canada within a couple of years of the publication of the study, a phenomenon that experts put down to the fact that women stopped taking HRT in droves.
The SOGC report said the cardiovascular and breast cancer risks related to older women – in their 60s and 70s – in the study, not the women in the early stages of menopause who they hoped to reach with the guidance published Thursday.
Reid said for the younger women, the evidence suggests short-term use has little influence on their risks of developing breast cancer. “And that is a message that has been lost on many women and their health-care providers who are now fearful about prescribing it.”
Commenting on the new Canadian guidance, the project officer for the Women’s Health Initiative acknowledged hormone replacement can be safely used for short-term relief of the symptoms of menopause. In fact, Dr. Jacques Rossouw said, “we said so in our original publication.”
“I would agree that the WHI data indicates that the risks of short-term hormone use in women immediately post menopausal, that these risks are low,” Rossouw, a researcher in cardiovascular disease prevention at the U.S. National Heart, Lung and Blood Institute, said from Bethesda, Md.
Rossouw added, however, that he felt the Society of Obstetricians and Gynaecologists of Canada were downplaying the risk of breast cancer and stroke, saying that even women who are just starting menopause are at elevated risk of both those conditions in the first five years of HRT use.
Even if the increased risk is small, exposing oneself to it to alleviate the symptoms of menopause might not be the right choice for some women, he said, suggesting women and their doctors should do an individual risk-benefits analysis.
“Look at your risk factors and consider whether you want to trade relief of symptoms for the real risk of … stroke, blood clots and breast cancer. It’s a real risk,” Rossouw said.
The society said women prescribed the drugs should start using them early in menopause and should use them over the short term – about five years – or until they no longer need them for symptom management. In a small percentage of women that could be quite a bit longer than five years; Reid said some women suffer menopausal symptoms for 20 years or more.
Similar advice has been issued by a number of other groups internationally, said Dr. Roger Lobo, former chair of obstetrics and gynecology at Columbia University in New York City. And Lobo said for obstetricians and gynecologists – obgyns in medical parlance – this would already be the standard approach.
But women suffering through menopause are more likely to see family physicians, who were heavily influenced by the reporting on the findings of the Women’s Health Initiative, Lobo and others said.
“The message probably doesn’t need to go so much to obgyns, because it’s like singing to the choir, so to speak,” Lobo said.
“It’s really the people on the front lines…. For them, if there’s any doubt, it’s probably easier to do nothing. This is often what happens.”