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When is it appropriate to prescribe postmenopausal hormone therapy?
Bruce Ettinger1, Elizabeth Barrett-Connor, Lalima A Hoq
1University of California, San Francisco, San Francisco, CA, USA. vmettinger@aol.com
Menopause (New York, N.Y.)
|June 1, 2006
Summary
Hormone therapy (HT) is appropriate for postmenopausal women with severe symptoms and no increased health risks. For women with risk factors, standard HT is often not suitable, but alternative doses or routes may be considered.
Area of Science:
- Reproductive Medicine
- Endocrinology
- Women's Health
Background:
- Postmenopausal hormone therapy (HT) is widely used for symptom management.
- Evidence-based guidelines are crucial for optimizing HT safety and efficacy.
- Consensus is needed to address diverse clinical scenarios in HT prescribing.
Framework:
- The RAND Appropriateness Method was employed by a multidisciplinary expert panel.
- Over 300 clinical scenarios were evaluated for HT appropriateness.
- A quantitative scale assessed treatment options based on patient risk factors.
Implementation:
- HT is appropriate for intolerable menopausal symptoms with usual cardiovascular disease (CVD), venous thromboembolism (VTE), or stroke risks.
- HT is not appropriate for bone preservation, cosmetic reasons, memory loss, libido, or CVD protection.
- For long-term HT users, dose reduction or discontinuation should be considered.
Implications:
- Standard HT is suitable for women with severe symptoms and no contraindicating risk factors.
- Repeated counseling on stopping or reducing HT is appropriate.
- Risk factors generally contraindicate standard-dose oral HT, but modified regimens may be suitable for select individuals.