HRT and Menopause

Menopause seems to be a staple for comedians and a recurring topic for myth and embarrassment among many, with little in the way of authoritative research discerning best management practices for healthcare providers or women making their way through this stage of life.  Now comes a document Rick and I discuss on PodMed this week,  issued by the British Menopause Society and taking a comprehensive look at the literature relative to hormone replacement therapy, or HRT.  As I comment in the podcast, recent research here at Hopkins by Wen Shen and colleagues demonstrates it's not a moment too soon, as even residents in obstetrics and gynecology nationally are sadly uniformed about menopause, although the average woman will spend almost a decade of her life in this transition and many will live a third of their lives after having passed through menopause!  Clearly an area where clarity is needed.

The British Menopause Society steps into the fray regarding HRT with a frank admission that confusion surrounds the issue, particularly in light of findings from both the Women's Health Initiative and the Million Women Study.  These studies scared the majority of women who were taking HRT with the specter of increased risk of cardiovascular disease, breast cancer and death, and caused many physicians to advise women not to take hormonal therapies.  Since then, reanalysis and additional information have rendered the original conclusions alarmist, with this paper broadly advising that each woman and her provider should assess her individual situation and constellation of risk factors, her symptomatology and comfort level, then make an informed choice.   In any case HRT should be used at the lowest possible dosage for the shortest period of time.

Women who still have a uterus should take progesterone in addition to estrogen, and therapy is ideally begun before a woman reaches age 60. Topically applied therapies can be considered for specific circumstances rather than oral medications.  The authors acknowledge that there is a two to four-fold increased risk of thromboembolism with the use of oral HRT, with the highest risk in the first year of therapy. They conclude that the risks for various types of cancer may be either elevated or reduced depending on the study examined, and that benefits or effects with regard to Alzheimer's disease, osteoporosis, skin health or the host of other issues women face as they age are still being discerned but may be positive.

Rick and I agree that we'd be much happier with the document if it also addressed exercise, other types of lifestyle changes, and use of antidepressants as a means of controlling hot flashes in greater detail, as these may be less potentially problematic than HRT, but we are glad to see this assessment and hope it will shed light on this issue for women and healthcare providers alike.

Other topics this week include medical emergencies on airplanes and universal MRSA decolonization for folks in the ICU in NEJM, and what to do about your anticoagulants if you're having a procedure in Neurology.  Until next week, y'all live well.

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HRT and Menopause | jhublogs
May 31, 2013 at 11:59 am

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Andy Heiz June 19, 2013 at 12:43 pm

In Flight Emergencies:
I also listen to the BBC HealthCheck podcast and the host Claudia Hammond covered the In Flight Emergencies story in deeper detail. The 5 or so minute piece features doctors who have been involved in these situations as well as the ground doctors who staff a helpline. The discussion focuses on the resources the doctors or other caregivers have at hand. The podcast was posted on June 12th and is available for 24 days after June 19th. Link to the site is below look for the podcast titled: In-flight emergencies, Thiel embalming, Sexual violence therapy 12 Jun 13


menopause June 13, 2013 at 8:32 am

It's the best time to make some plans for the future and it's time to be happy.
I have read this post and if I could I desire to suggest you some interesting things or suggestions.
Perhaps you could write next articles referring to
this article. I want to read even more things about it!


Sebastian June 1, 2013 at 8:49 am

I would really be interested in the link to more information about medical emergencies on planes.

Thank you!


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