August 2016 Health Bulletin

Menopausal hormone therapy (often called HRT) still scares women while the experts try to dispel fears

The first publication from the Women's Health Initiative (WHI) HRT study in 2002 created headline news across the globe instilling fear in current and potential future users of HRT. Women stopped their hormone therapy when they read the headline: "HRT causes breast cancer". Over a decade later the majority of women highly symptomatic from the fall of hormone at menopause either grin and bare their symptoms, or take over the counter remedies that simply do not work. Few take HRT.

But what do the experts say about the HRT "taboo"?

Dr JoAnn Manson, one of the lead investigators for the WHI hormone therapy studies recently wrote strongly in support of the use of HRT saying "Professional societies… and others support the use of systemic hormone therapy in symptomatic, recently menopausal women who don't have contraindications, such as an excess risk of breast cancer or cardiovascular disease, and who have a personal preference for such therapy. For women in this category who have moderate-to-severe vasomotor symptoms, a consensus has emerged that the benefits of hormone therapy are likely to outweigh the risks." She added, "Reluctance to treat menopausal symptoms has derailed and fragmented the clinical care of midlife women, creating a large and unnecessary burden of suffering."1

The international consensus, and recommendation, is that the benefits of HRT are more likely to outweigh any risks if HRT is initiated for most symptomatic women before the age of 60 years or within 10 years after menopause. The concept that women should stop HRT after 5 years has been dismissed. Rather women should continue therapy in line with their needs and the treatment goals. This means that some women take HRT for a brief period whereas others might use HRT for many years.

Women uncertain about HRT should seek out a doctor knowledgeable in this area. Unfortunately not all doctors have kept up to date with management of menopause and hormone therapy. Doctors working in the field of menopause can be found on the Australasian Menopause Society Website at the Find an AMS doctor link.

1 Manson JE, Kaunitz AM. Menopause Management--Getting Clinical Care Back on Track. N Engl J Med. 2016;374(9):803-6.

Does HRT help your blood vessels stay healthy?

A paper published in the New England Journal of Medicine March 2016 supports blood vessel health benefits of oral estrogen therapy over that of placebo therapy2. The study that involved 643 women showed that women allocated to estrogen, with or without progesterone, developed less atherosclerosis (fatty deposit) build up in their carotid arteries over 5 years. Of importance, this benefit was seen in women who started treatment within 6 years of menopause, but not in women who started treatment ten or more years after menopause.

The study was supported by the National Institutes of Health, USA.

2 Hodis HN, Mack WJ, Henderson VW, Shoupe D, Budoff MJ, Hwang-Levine J, et al. Vascular Effects of Early versus Late Postmenopausal Treatment with Estradiol. N Engl J Med. 2016;374(13):1221-31.

The Grollo Ruzzene Foundation Younger Women's Health Study

We are delighted to announce the launch of this study to determine the health needs of younger Australian women. The generous support of the Grollo Ruzzene Foundation will enable us to profile the physical and psychological health of 7,000 Australian women aged 18-39 years. Our partners in the study are Roy Morgan Research, Melbourne Pathology and Sonic Pathology. We believe this will be a landmark study, informing of the issues that most concern women of this age. Recruitment to the study will commence in the coming months with the first findings expected in 2017.

Information provided might not be relevant to a particular person's circumstances and should always be discussed with that person's own healthcare provider.