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Menopausal Hormone Therapy is the New HRT Part 2

Posted Mar 19 2013 3:00am
Yesterday, I noted the first 4 global consensus statements regarding our current knowledge & view of menopausal hormone treatment (MHT), formerly known as hormone replacement therapy (HRT), aka estrogen replacement therapy (ERT).  For a quick refresher, let's remember that these recommendations only apply to women <60yo and/or <10yrs post-menopause.  With that in mind . . .

5) Estrogen alone is appropriate after hysterectomy but additional progestogen must be used if uterus present (nothing new here);
6) MHT is a personal decision that needs to balance risk vs benefit (nothing new here either); 7) MHT increases risk of clotting problems eg deep vein thrombosis & ischemic stroke, but absolute risk remains low if <60yo; observational study suggests transdermal MHT is associated w/even lower risk of clotting issue (which is why I've been advocating creams or patches rather than pills); 8) Increased risk of breast cancer is associated w/progestogen use & related to duration of use; as w/DVT & stroke, absolute risk is low & decreases after MHT is stopped.
This last point is one of vindication for me & many others as we thought it odd that while the E+P arm of Women's Health Initiative was linked to breast cancer & the E only arm wasn't, all the blame for breast cancer was laid at the feet of E.

And yet we see this same rush to judg(e)ment with the recent HPS2-THRIVE study in which niacin+laropiprant was compared to placebo rather than to niacin and yet niacin was blamed for the bad outcome , rather than positing that perhaps this novel agent, laropiprant was the cause.  Don't get me wrong.   I'm not saying that niacin is a great drug but rather that we can't blame it alone for bad outcomes when the study didn't compare it alone to placebo, but rather it in combination w/an unknown drug to placebo.

Stay tuned for Part 3 of this look at the Global Consensus Statement on menopausal hormone therapy .

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