In the center of the city in the center of life with passion for care

Serge Rozenberg CHU St Pierre ULB-VUB Belgium

serge_rozenbergstpierre-brube

laquo Prise en charge de la meacutenopause raquo

7918 AMUB

La lute pour les droits de la femme nrsquoest pas

termineacutee

Manifestation ce dimanche

La carvanne des femmes

Conflict of interest amp Disclosure

Conflict of interest None

Disclosure SR

Research funding IRIS- King Baudouin

Fondation Vesale research Foundation Amgen

MSD

Speakers bureau ampor Advisory Boards

Abbot Pfizer Will Gedeon Richter MSD

Amgen Serylis Pharma

Concours

bull Ne pas oublier de reacutepondre hellipSinon on ne peut pas gagner

Goals

Risk Benefit of MHT

Indications - Contraindications

Mrs V Her Complaint

bull 52 years old

bull Has suffered from severe hot flushes(7 timesday) and night sweats (4 times night)for 6 months

bull She complains also about breast tenderness

bull Her last menstruation occurred 3 months ago

Patient case developed for educational purposes only

1 Sherman S Am J Med 2005118(128) 3S-7S

Defining the Menopausal

Transition1

FSH Follical Stimulating Hormone

Menopause stages most likely to be associated with vasomotor symptoms

Patterns of Estradiol Progesterone

Luteinizing and Follicle-stimulating

Hormones1

1 Santoro N Am J Med 2005 118 (12B) 8Sndash13S

Patterns of estradiol progesterone luteinizing hormone and follicle-stimulating hormone levels in a sample of 8 midreproductive-aged (MRA) and 14 older reproductive-aged (ORA) women Error bars indicate mean plusmn 10 standard error

Pooled Estimates of Proportion of

Vasomotor Symptoms During

Perimenopause1

1 Politi MC et al J Gen Intern Med 23(9)1507ndash13

Pooled estimates of proportion of vasomotor symptoms by year tofrom final menstrual period Six studies provided data for the main meta-analysis One was longitudinal and the others were cross-sectional

Mrs V Her Complaint

bull 52 years old

bull Has suffered from severe hot flushes(7 timesday) and night sweats (4 times night)for 6 months

bull She complains also about breast tenderness

bull Her last menstruation occurred 13 months ago

Patient case developed for educational purposes only

Womens experience of the menopause problem symptoms

Hot flushes

Night sweats

Sleep problems

Dry v agina

0

10

20

30

40

50

60

70

Experienced symptoms

Experienced as problems

Adapted from Porter et al 1996

Womens experience of the menopause problem symptoms

Painful joints

Headaches

Concentration problems

Depression

0

10

20

30

40

50

60

70

Experienced symptoms

Experienced as problems

Adapted from Porter et al 1996

Indication of therapy

Flushes

bull Over half (503) of postmenopausal women experienced either mild (246) moderate (176) or severe (81) VMS

bull DiBonaventura et al Int J WomensHealth 2013 May 245261-9

La lute pour les droits de la femme nrsquoest pas

termineacutee

Manifestation ce dimanche

La carvanne des femmes

Conflict of interest amp Disclosure

Conflict of interest None

Disclosure SR

Research funding IRIS- King Baudouin

Fondation Vesale research Foundation Amgen

MSD

Speakers bureau ampor Advisory Boards

Abbot Pfizer Will Gedeon Richter MSD

Amgen Serylis Pharma

Concours

bull Ne pas oublier de reacutepondre hellipSinon on ne peut pas gagner

Goals

Risk Benefit of MHT

Indications - Contraindications

Mrs V Her Complaint

bull 52 years old

bull Has suffered from severe hot flushes(7 timesday) and night sweats (4 times night)for 6 months

bull She complains also about breast tenderness

bull Her last menstruation occurred 3 months ago

Patient case developed for educational purposes only

1 Sherman S Am J Med 2005118(128) 3S-7S

Defining the Menopausal

Transition1

FSH Follical Stimulating Hormone

Menopause stages most likely to be associated with vasomotor symptoms

Patterns of Estradiol Progesterone

Luteinizing and Follicle-stimulating

Hormones1

1 Santoro N Am J Med 2005 118 (12B) 8Sndash13S

Patterns of estradiol progesterone luteinizing hormone and follicle-stimulating hormone levels in a sample of 8 midreproductive-aged (MRA) and 14 older reproductive-aged (ORA) women Error bars indicate mean plusmn 10 standard error

Pooled Estimates of Proportion of

Vasomotor Symptoms During

Perimenopause1

1 Politi MC et al J Gen Intern Med 23(9)1507ndash13

Pooled estimates of proportion of vasomotor symptoms by year tofrom final menstrual period Six studies provided data for the main meta-analysis One was longitudinal and the others were cross-sectional

Mrs V Her Complaint

bull 52 years old

bull Has suffered from severe hot flushes(7 timesday) and night sweats (4 times night)for 6 months

bull She complains also about breast tenderness

bull Her last menstruation occurred 13 months ago

Patient case developed for educational purposes only

Womens experience of the menopause problem symptoms

Hot flushes

Night sweats

Sleep problems

Dry v agina

0

10

20

30

40

50

60

70

Experienced symptoms

Experienced as problems

Adapted from Porter et al 1996

Womens experience of the menopause problem symptoms

Painful joints

Headaches

Concentration problems

Depression

0

10

20

30

40

50

60

70

Experienced symptoms

Experienced as problems

Adapted from Porter et al 1996

Indication of therapy

Flushes

bull Over half (503) of postmenopausal women experienced either mild (246) moderate (176) or severe (81) VMS

bull DiBonaventura et al Int J WomensHealth 2013 May 245261-9

Conflict of interest amp Disclosure

Conflict of interest None

Disclosure SR

Research funding IRIS- King Baudouin

Fondation Vesale research Foundation Amgen

MSD

Speakers bureau ampor Advisory Boards

Abbot Pfizer Will Gedeon Richter MSD

Amgen Serylis Pharma

Concours

bull Ne pas oublier de reacutepondre hellipSinon on ne peut pas gagner

Goals

Risk Benefit of MHT

Indications - Contraindications

Mrs V Her Complaint

bull 52 years old

bull Has suffered from severe hot flushes(7 timesday) and night sweats (4 times night)for 6 months

bull She complains also about breast tenderness

bull Her last menstruation occurred 3 months ago

Patient case developed for educational purposes only

1 Sherman S Am J Med 2005118(128) 3S-7S

Defining the Menopausal

Transition1

FSH Follical Stimulating Hormone

Menopause stages most likely to be associated with vasomotor symptoms

Patterns of Estradiol Progesterone

Luteinizing and Follicle-stimulating

Hormones1

1 Santoro N Am J Med 2005 118 (12B) 8Sndash13S

Patterns of estradiol progesterone luteinizing hormone and follicle-stimulating hormone levels in a sample of 8 midreproductive-aged (MRA) and 14 older reproductive-aged (ORA) women Error bars indicate mean plusmn 10 standard error

Pooled Estimates of Proportion of

Vasomotor Symptoms During

Perimenopause1

1 Politi MC et al J Gen Intern Med 23(9)1507ndash13

Pooled estimates of proportion of vasomotor symptoms by year tofrom final menstrual period Six studies provided data for the main meta-analysis One was longitudinal and the others were cross-sectional

Mrs V Her Complaint

bull 52 years old

bull Has suffered from severe hot flushes(7 timesday) and night sweats (4 times night)for 6 months

bull She complains also about breast tenderness

bull Her last menstruation occurred 13 months ago

Patient case developed for educational purposes only

Womens experience of the menopause problem symptoms

Hot flushes

Night sweats

Sleep problems

Dry v agina

0

10

20

30

40

50

60

70

Experienced symptoms

Experienced as problems

Adapted from Porter et al 1996

Womens experience of the menopause problem symptoms

Painful joints

Headaches

Concentration problems

Depression

0

10

20

30

40

50

60

70

Experienced symptoms

Experienced as problems

Adapted from Porter et al 1996

Indication of therapy

Flushes

bull Over half (503) of postmenopausal women experienced either mild (246) moderate (176) or severe (81) VMS

bull DiBonaventura et al Int J WomensHealth 2013 May 245261-9

Concours

bull Ne pas oublier de reacutepondre hellipSinon on ne peut pas gagner

Goals

Risk Benefit of MHT

Indications - Contraindications

Mrs V Her Complaint

bull 52 years old

bull Has suffered from severe hot flushes(7 timesday) and night sweats (4 times night)for 6 months

bull She complains also about breast tenderness

bull Her last menstruation occurred 3 months ago

Patient case developed for educational purposes only

1 Sherman S Am J Med 2005118(128) 3S-7S

Defining the Menopausal

Transition1

FSH Follical Stimulating Hormone

Menopause stages most likely to be associated with vasomotor symptoms

Patterns of Estradiol Progesterone

Luteinizing and Follicle-stimulating

Hormones1

1 Santoro N Am J Med 2005 118 (12B) 8Sndash13S

Patterns of estradiol progesterone luteinizing hormone and follicle-stimulating hormone levels in a sample of 8 midreproductive-aged (MRA) and 14 older reproductive-aged (ORA) women Error bars indicate mean plusmn 10 standard error

Pooled Estimates of Proportion of

Vasomotor Symptoms During

Perimenopause1

1 Politi MC et al J Gen Intern Med 23(9)1507ndash13

Pooled estimates of proportion of vasomotor symptoms by year tofrom final menstrual period Six studies provided data for the main meta-analysis One was longitudinal and the others were cross-sectional

Mrs V Her Complaint

bull 52 years old

bull Has suffered from severe hot flushes(7 timesday) and night sweats (4 times night)for 6 months

bull She complains also about breast tenderness

bull Her last menstruation occurred 13 months ago

Patient case developed for educational purposes only

Womens experience of the menopause problem symptoms

Hot flushes

Night sweats

Sleep problems

Dry v agina

0

10

20

30

40

50

60

70

Experienced symptoms

Experienced as problems

Adapted from Porter et al 1996

Womens experience of the menopause problem symptoms

Painful joints

Headaches

Concentration problems

Depression

0

10

20

30

40

50

60

70

Experienced symptoms

Experienced as problems

Adapted from Porter et al 1996

Indication of therapy

Flushes

bull Over half (503) of postmenopausal women experienced either mild (246) moderate (176) or severe (81) VMS

bull DiBonaventura et al Int J WomensHealth 2013 May 245261-9

Goals

Risk Benefit of MHT

Indications - Contraindications

Mrs V Her Complaint

bull 52 years old

bull Has suffered from severe hot flushes(7 timesday) and night sweats (4 times night)for 6 months

bull She complains also about breast tenderness

bull Her last menstruation occurred 3 months ago

Patient case developed for educational purposes only

1 Sherman S Am J Med 2005118(128) 3S-7S

Defining the Menopausal

Transition1

FSH Follical Stimulating Hormone

Menopause stages most likely to be associated with vasomotor symptoms

Patterns of Estradiol Progesterone

Luteinizing and Follicle-stimulating

Hormones1

1 Santoro N Am J Med 2005 118 (12B) 8Sndash13S

Patterns of estradiol progesterone luteinizing hormone and follicle-stimulating hormone levels in a sample of 8 midreproductive-aged (MRA) and 14 older reproductive-aged (ORA) women Error bars indicate mean plusmn 10 standard error

Pooled Estimates of Proportion of

Vasomotor Symptoms During

Perimenopause1

1 Politi MC et al J Gen Intern Med 23(9)1507ndash13

Pooled estimates of proportion of vasomotor symptoms by year tofrom final menstrual period Six studies provided data for the main meta-analysis One was longitudinal and the others were cross-sectional

Mrs V Her Complaint

bull 52 years old

bull Has suffered from severe hot flushes(7 timesday) and night sweats (4 times night)for 6 months

bull She complains also about breast tenderness

bull Her last menstruation occurred 13 months ago

Patient case developed for educational purposes only

Womens experience of the menopause problem symptoms

Hot flushes

Night sweats

Sleep problems

Dry v agina

0

10

20

30

40

50

60

70

Experienced symptoms

Experienced as problems

Adapted from Porter et al 1996

Womens experience of the menopause problem symptoms

Painful joints

Headaches

Concentration problems

Depression

0

10

20

30

40

50

60

70

Experienced symptoms

Experienced as problems

Adapted from Porter et al 1996

Indication of therapy

Flushes

bull Over half (503) of postmenopausal women experienced either mild (246) moderate (176) or severe (81) VMS

bull DiBonaventura et al Int J WomensHealth 2013 May 245261-9

Mrs V Her Complaint

bull 52 years old

bull Has suffered from severe hot flushes(7 timesday) and night sweats (4 times night)for 6 months

bull She complains also about breast tenderness

bull Her last menstruation occurred 3 months ago

Patient case developed for educational purposes only

1 Sherman S Am J Med 2005118(128) 3S-7S

Defining the Menopausal

Transition1

FSH Follical Stimulating Hormone

Menopause stages most likely to be associated with vasomotor symptoms

Patterns of Estradiol Progesterone

Luteinizing and Follicle-stimulating

Hormones1

1 Santoro N Am J Med 2005 118 (12B) 8Sndash13S

Patterns of estradiol progesterone luteinizing hormone and follicle-stimulating hormone levels in a sample of 8 midreproductive-aged (MRA) and 14 older reproductive-aged (ORA) women Error bars indicate mean plusmn 10 standard error

Pooled Estimates of Proportion of

Vasomotor Symptoms During

Perimenopause1

1 Politi MC et al J Gen Intern Med 23(9)1507ndash13

Pooled estimates of proportion of vasomotor symptoms by year tofrom final menstrual period Six studies provided data for the main meta-analysis One was longitudinal and the others were cross-sectional

Mrs V Her Complaint

bull 52 years old

bull Has suffered from severe hot flushes(7 timesday) and night sweats (4 times night)for 6 months

bull She complains also about breast tenderness

bull Her last menstruation occurred 13 months ago

Patient case developed for educational purposes only

Womens experience of the menopause problem symptoms

Hot flushes

Night sweats

Sleep problems

Dry v agina

0

10

20

30

40

50

60

70

Experienced symptoms

Experienced as problems

Adapted from Porter et al 1996

Womens experience of the menopause problem symptoms

Painful joints

Headaches

Concentration problems

Depression

0

10

20

30

40

50

60

70

Experienced symptoms

Experienced as problems

Adapted from Porter et al 1996

Indication of therapy

Flushes

bull Over half (503) of postmenopausal women experienced either mild (246) moderate (176) or severe (81) VMS

bull DiBonaventura et al Int J WomensHealth 2013 May 245261-9

1 Sherman S Am J Med 2005118(128) 3S-7S

Defining the Menopausal

Transition1

FSH Follical Stimulating Hormone

Menopause stages most likely to be associated with vasomotor symptoms

Patterns of Estradiol Progesterone

Luteinizing and Follicle-stimulating

Hormones1

1 Santoro N Am J Med 2005 118 (12B) 8Sndash13S

Patterns of estradiol progesterone luteinizing hormone and follicle-stimulating hormone levels in a sample of 8 midreproductive-aged (MRA) and 14 older reproductive-aged (ORA) women Error bars indicate mean plusmn 10 standard error

Pooled Estimates of Proportion of

Vasomotor Symptoms During

Perimenopause1

1 Politi MC et al J Gen Intern Med 23(9)1507ndash13

Pooled estimates of proportion of vasomotor symptoms by year tofrom final menstrual period Six studies provided data for the main meta-analysis One was longitudinal and the others were cross-sectional

Mrs V Her Complaint

bull 52 years old

bull Has suffered from severe hot flushes(7 timesday) and night sweats (4 times night)for 6 months

bull She complains also about breast tenderness

bull Her last menstruation occurred 13 months ago

Patient case developed for educational purposes only

Womens experience of the menopause problem symptoms

Hot flushes

Night sweats

Sleep problems

Dry v agina

0

10

20

30

40

50

60

70

Experienced symptoms

Experienced as problems

Adapted from Porter et al 1996

Womens experience of the menopause problem symptoms

Painful joints

Headaches

Concentration problems

Depression

0

10

20

30

40

50

60

70

Experienced symptoms

Experienced as problems

Adapted from Porter et al 1996

Indication of therapy

Flushes

bull Over half (503) of postmenopausal women experienced either mild (246) moderate (176) or severe (81) VMS

bull DiBonaventura et al Int J WomensHealth 2013 May 245261-9

Patterns of Estradiol Progesterone

Luteinizing and Follicle-stimulating

Hormones1

1 Santoro N Am J Med 2005 118 (12B) 8Sndash13S

Patterns of estradiol progesterone luteinizing hormone and follicle-stimulating hormone levels in a sample of 8 midreproductive-aged (MRA) and 14 older reproductive-aged (ORA) women Error bars indicate mean plusmn 10 standard error

Pooled Estimates of Proportion of

Vasomotor Symptoms During

Perimenopause1

1 Politi MC et al J Gen Intern Med 23(9)1507ndash13

Pooled estimates of proportion of vasomotor symptoms by year tofrom final menstrual period Six studies provided data for the main meta-analysis One was longitudinal and the others were cross-sectional

Mrs V Her Complaint

bull 52 years old

bull Has suffered from severe hot flushes(7 timesday) and night sweats (4 times night)for 6 months

bull She complains also about breast tenderness

bull Her last menstruation occurred 13 months ago

Patient case developed for educational purposes only

Womens experience of the menopause problem symptoms

Hot flushes

Night sweats

Sleep problems

Dry v agina

0

10

20

30

40

50

60

70

Experienced symptoms

Experienced as problems

Adapted from Porter et al 1996

Womens experience of the menopause problem symptoms

Painful joints

Headaches

Concentration problems

Depression

0

10

20

30

40

50

60

70

Experienced symptoms

Experienced as problems

Adapted from Porter et al 1996

Indication of therapy

Flushes

bull Over half (503) of postmenopausal women experienced either mild (246) moderate (176) or severe (81) VMS

bull DiBonaventura et al Int J WomensHealth 2013 May 245261-9

Pooled Estimates of Proportion of

Vasomotor Symptoms During

Perimenopause1

1 Politi MC et al J Gen Intern Med 23(9)1507ndash13

Pooled estimates of proportion of vasomotor symptoms by year tofrom final menstrual period Six studies provided data for the main meta-analysis One was longitudinal and the others were cross-sectional

Mrs V Her Complaint

bull 52 years old

bull Has suffered from severe hot flushes(7 timesday) and night sweats (4 times night)for 6 months

bull She complains also about breast tenderness

bull Her last menstruation occurred 13 months ago

Patient case developed for educational purposes only

Womens experience of the menopause problem symptoms

Hot flushes

Night sweats

Sleep problems

Dry v agina

0

10

20

30

40

50

60

70

Experienced symptoms

Experienced as problems

Adapted from Porter et al 1996

Womens experience of the menopause problem symptoms

Painful joints

Headaches

Concentration problems

Depression

0

10

20

30

40

50

60

70

Experienced symptoms

Experienced as problems

Adapted from Porter et al 1996

Indication of therapy

Flushes

bull Over half (503) of postmenopausal women experienced either mild (246) moderate (176) or severe (81) VMS

bull DiBonaventura et al Int J WomensHealth 2013 May 245261-9

Mrs V Her Complaint

bull 52 years old

bull Has suffered from severe hot flushes(7 timesday) and night sweats (4 times night)for 6 months

bull She complains also about breast tenderness

bull Her last menstruation occurred 13 months ago

Patient case developed for educational purposes only

Womens experience of the menopause problem symptoms

Hot flushes

Night sweats

Sleep problems

Dry v agina

0

10

20

30

40

50

60

70

Experienced symptoms

Experienced as problems

Adapted from Porter et al 1996

Womens experience of the menopause problem symptoms

Painful joints

Headaches

Concentration problems

Depression

0

10

20

30

40

50

60

70

Experienced symptoms

Experienced as problems

Adapted from Porter et al 1996

Indication of therapy

Flushes

bull Over half (503) of postmenopausal women experienced either mild (246) moderate (176) or severe (81) VMS

bull DiBonaventura et al Int J WomensHealth 2013 May 245261-9

Womens experience of the menopause problem symptoms

Hot flushes

Night sweats

Sleep problems

Dry v agina

0

10

20

30

40

50

60

70

Experienced symptoms

Experienced as problems

Adapted from Porter et al 1996

Womens experience of the menopause problem symptoms

Painful joints

Headaches

Concentration problems

Depression

0

10

20

30

40

50

60

70

Experienced symptoms

Experienced as problems

Adapted from Porter et al 1996

Indication of therapy

Flushes

bull Over half (503) of postmenopausal women experienced either mild (246) moderate (176) or severe (81) VMS

bull DiBonaventura et al Int J WomensHealth 2013 May 245261-9

Womens experience of the menopause problem symptoms

Painful joints

Headaches

Concentration problems

Depression

0

10

20

30

40

50

60

70

Experienced symptoms

Experienced as problems

Adapted from Porter et al 1996

Indication of therapy

Flushes

bull Over half (503) of postmenopausal women experienced either mild (246) moderate (176) or severe (81) VMS

bull DiBonaventura et al Int J WomensHealth 2013 May 245261-9

Indication of therapy

Flushes

bull Over half (503) of postmenopausal women experienced either mild (246) moderate (176) or severe (81) VMS

bull DiBonaventura et al Int J WomensHealth 2013 May 245261-9

Flushes

bull Over half (503) of postmenopausal women experienced either mild (246) moderate (176) or severe (81) VMS

bull DiBonaventura et al Int J WomensHealth 2013 May 245261-9

The Impact of Menopausal Symptoms on

Quality of Life Productivity and Economic

Outcomes

Whiteley et al JOURNAL OF WOMENrsquoS HEALTH Volume 22 Number 11 2013

HRT reduces symptom frequencye and severity as

compared with placebo OR= 013 95 CI 008-022

MacLennan et al Climacteric 2001 Mar4(1)58-74Cochrane review

Antoine Ameye Paesmans Rozenberg Maturitas 2016

In favour of MHT

bull Timing of treatment

bull Choice of treatment

bull Low dose

bull Regimen with the least innocuousness

Dose Response to Estrogen Therapy

Notelovitz et al Obstet Gynecol 200095726

Number of moderate-severe hot flushes

80

70

60

50

40

30

20

10

0

0 1 2 3 4 5 6 7 8 9 10 11 12

Placebo

025 mg E2

05 mg E2

1 mg E2

2 mg E2

Significantly different from

placebo (Plt005)

-40

Efficacy of 1mg E2 + 05mg NETA

on BMD

Adapted from McClung et al 1998

L1-L4 Femoral Neck Femoral Trochanter

0

2

4

6

-2

-4

BMD change af ter 26 months

placebo E2 025mg E2 05mg E2 1mg

E2 1mgNETA 025mg E2 1mgNETA 05mg E2 2mgNETA 1mg

Endogenous hormones and risk of Hip amp

vertebral fractures among older women

Cummings et al NEJM1998

No Increase in Fractures After Stopping Hormone Therapy

Results From the Womens Health Initiative

bull Examine fractures after discontinuation of HT

bull 2 RCT (CEE+ MPA) CEE alone) WHI participants (N = 15187) who continued active HT or placebo through the intervention period and who did not take HT in the post-intervention period

bull Hip fractures were infrequent (sim25 1000 person-years) this finding was similar between trials and in former HT and placebo groups

bull CEE + MPA trial No difference in total fractures HR= 097 95 CI 087 -109 P = 063)

bull CEE-alone trial higher total fractures in former placebo users (3691000 person-years vs former active group 3111000 person-years) residual benefit of CEE (HR 085 95 CI 073 to 098 P = 003)

bull Watts et al J Clin Endocrinol Metab 2017 Jan 1102(1)302-308

HRT reduces symptom frequencye and severity as

compared with placebo OR= 013 95 CI 008-022

MacLennan et al Climacteric 2001 Mar4(1)58-74Cochrane review

Antoine Ameye Paesmans Rozenberg Maturitas 2016

In favour of MHT

bull Timing of treatment

bull Choice of treatment

bull Low dose

bull Regimen with the least innocuousness

Dose Response to Estrogen Therapy

Notelovitz et al Obstet Gynecol 200095726

Number of moderate-severe hot flushes

80

70

60

50

40

30

20

10

0

0 1 2 3 4 5 6 7 8 9 10 11 12

Placebo

025 mg E2

05 mg E2

1 mg E2

2 mg E2

Significantly different from

placebo (Plt005)

-40

Efficacy of 1mg E2 + 05mg NETA

on BMD

Adapted from McClung et al 1998

L1-L4 Femoral Neck Femoral Trochanter

0

2

4

6

-2

-4

BMD change af ter 26 months

placebo E2 025mg E2 05mg E2 1mg

E2 1mgNETA 025mg E2 1mgNETA 05mg E2 2mgNETA 1mg

Endogenous hormones and risk of Hip amp

vertebral fractures among older women

Cummings et al NEJM1998

No Increase in Fractures After Stopping Hormone Therapy

Results From the Womens Health Initiative

bull Examine fractures after discontinuation of HT

bull 2 RCT (CEE+ MPA) CEE alone) WHI participants (N = 15187) who continued active HT or placebo through the intervention period and who did not take HT in the post-intervention period

bull Hip fractures were infrequent (sim25 1000 person-years) this finding was similar between trials and in former HT and placebo groups

bull CEE + MPA trial No difference in total fractures HR= 097 95 CI 087 -109 P = 063)

bull CEE-alone trial higher total fractures in former placebo users (3691000 person-years vs former active group 3111000 person-years) residual benefit of CEE (HR 085 95 CI 073 to 098 P = 003)

bull Watts et al J Clin Endocrinol Metab 2017 Jan 1102(1)302-308

Antoine Ameye Paesmans Rozenberg Maturitas 2016

In favour of MHT

bull Timing of treatment

bull Choice of treatment

bull Low dose

bull Regimen with the least innocuousness

Dose Response to Estrogen Therapy

Notelovitz et al Obstet Gynecol 200095726

Number of moderate-severe hot flushes

80

70

60

50

40

30

20

10

0

0 1 2 3 4 5 6 7 8 9 10 11 12

Placebo

025 mg E2

05 mg E2

1 mg E2

2 mg E2

Significantly different from

placebo (Plt005)

-40

Efficacy of 1mg E2 + 05mg NETA

on BMD

Adapted from McClung et al 1998

L1-L4 Femoral Neck Femoral Trochanter

0

2

4

6

-2

-4

BMD change af ter 26 months

placebo E2 025mg E2 05mg E2 1mg

E2 1mgNETA 025mg E2 1mgNETA 05mg E2 2mgNETA 1mg

Endogenous hormones and risk of Hip amp

vertebral fractures among older women

Cummings et al NEJM1998

No Increase in Fractures After Stopping Hormone Therapy

Results From the Womens Health Initiative

bull Examine fractures after discontinuation of HT

bull 2 RCT (CEE+ MPA) CEE alone) WHI participants (N = 15187) who continued active HT or placebo through the intervention period and who did not take HT in the post-intervention period

bull Hip fractures were infrequent (sim25 1000 person-years) this finding was similar between trials and in former HT and placebo groups

bull CEE + MPA trial No difference in total fractures HR= 097 95 CI 087 -109 P = 063)

bull CEE-alone trial higher total fractures in former placebo users (3691000 person-years vs former active group 3111000 person-years) residual benefit of CEE (HR 085 95 CI 073 to 098 P = 003)

bull Watts et al J Clin Endocrinol Metab 2017 Jan 1102(1)302-308

In favour of MHT

bull Timing of treatment

bull Choice of treatment

bull Low dose

bull Regimen with the least innocuousness

Dose Response to Estrogen Therapy

Notelovitz et al Obstet Gynecol 200095726

Number of moderate-severe hot flushes

80

70

60

50

40

30

20

10

0

0 1 2 3 4 5 6 7 8 9 10 11 12

Placebo

025 mg E2

05 mg E2

1 mg E2

2 mg E2

Significantly different from

placebo (Plt005)

-40

Efficacy of 1mg E2 + 05mg NETA

on BMD

Adapted from McClung et al 1998

L1-L4 Femoral Neck Femoral Trochanter

0

2

4

6

-2

-4

BMD change af ter 26 months

placebo E2 025mg E2 05mg E2 1mg

E2 1mgNETA 025mg E2 1mgNETA 05mg E2 2mgNETA 1mg

Endogenous hormones and risk of Hip amp

vertebral fractures among older women

Cummings et al NEJM1998

No Increase in Fractures After Stopping Hormone Therapy

Results From the Womens Health Initiative

bull Examine fractures after discontinuation of HT

bull 2 RCT (CEE+ MPA) CEE alone) WHI participants (N = 15187) who continued active HT or placebo through the intervention period and who did not take HT in the post-intervention period

bull Hip fractures were infrequent (sim25 1000 person-years) this finding was similar between trials and in former HT and placebo groups

bull CEE + MPA trial No difference in total fractures HR= 097 95 CI 087 -109 P = 063)

bull CEE-alone trial higher total fractures in former placebo users (3691000 person-years vs former active group 3111000 person-years) residual benefit of CEE (HR 085 95 CI 073 to 098 P = 003)

bull Watts et al J Clin Endocrinol Metab 2017 Jan 1102(1)302-308

bull Timing of treatment

bull Choice of treatment

bull Low dose

bull Regimen with the least innocuousness

Dose Response to Estrogen Therapy

Notelovitz et al Obstet Gynecol 200095726

Number of moderate-severe hot flushes

80

70

60

50

40

30

20

10

0

0 1 2 3 4 5 6 7 8 9 10 11 12

Placebo

025 mg E2

05 mg E2

1 mg E2

2 mg E2

Significantly different from

placebo (Plt005)

-40

Efficacy of 1mg E2 + 05mg NETA

on BMD

Adapted from McClung et al 1998

L1-L4 Femoral Neck Femoral Trochanter

0

2

4

6

-2

-4

BMD change af ter 26 months

placebo E2 025mg E2 05mg E2 1mg

E2 1mgNETA 025mg E2 1mgNETA 05mg E2 2mgNETA 1mg

Endogenous hormones and risk of Hip amp

vertebral fractures among older women

Cummings et al NEJM1998

No Increase in Fractures After Stopping Hormone Therapy

Results From the Womens Health Initiative

bull Examine fractures after discontinuation of HT

bull 2 RCT (CEE+ MPA) CEE alone) WHI participants (N = 15187) who continued active HT or placebo through the intervention period and who did not take HT in the post-intervention period

bull Hip fractures were infrequent (sim25 1000 person-years) this finding was similar between trials and in former HT and placebo groups

bull CEE + MPA trial No difference in total fractures HR= 097 95 CI 087 -109 P = 063)

bull CEE-alone trial higher total fractures in former placebo users (3691000 person-years vs former active group 3111000 person-years) residual benefit of CEE (HR 085 95 CI 073 to 098 P = 003)

bull Watts et al J Clin Endocrinol Metab 2017 Jan 1102(1)302-308

Dose Response to Estrogen Therapy

Notelovitz et al Obstet Gynecol 200095726

Number of moderate-severe hot flushes

80

70

60

50

40

30

20

10

0

0 1 2 3 4 5 6 7 8 9 10 11 12

Placebo

025 mg E2

05 mg E2

1 mg E2

2 mg E2

Significantly different from

placebo (Plt005)

-40

Efficacy of 1mg E2 + 05mg NETA

on BMD

Adapted from McClung et al 1998

L1-L4 Femoral Neck Femoral Trochanter

0

2

4

6

-2

-4

BMD change af ter 26 months

placebo E2 025mg E2 05mg E2 1mg

E2 1mgNETA 025mg E2 1mgNETA 05mg E2 2mgNETA 1mg

Endogenous hormones and risk of Hip amp

vertebral fractures among older women

Cummings et al NEJM1998

No Increase in Fractures After Stopping Hormone Therapy

Results From the Womens Health Initiative

bull Examine fractures after discontinuation of HT

bull 2 RCT (CEE+ MPA) CEE alone) WHI participants (N = 15187) who continued active HT or placebo through the intervention period and who did not take HT in the post-intervention period

bull Hip fractures were infrequent (sim25 1000 person-years) this finding was similar between trials and in former HT and placebo groups

bull CEE + MPA trial No difference in total fractures HR= 097 95 CI 087 -109 P = 063)

bull CEE-alone trial higher total fractures in former placebo users (3691000 person-years vs former active group 3111000 person-years) residual benefit of CEE (HR 085 95 CI 073 to 098 P = 003)

bull Watts et al J Clin Endocrinol Metab 2017 Jan 1102(1)302-308

-40

Efficacy of 1mg E2 + 05mg NETA

on BMD

Adapted from McClung et al 1998

L1-L4 Femoral Neck Femoral Trochanter

0

2

4

6

-2

-4

BMD change af ter 26 months

placebo E2 025mg E2 05mg E2 1mg

E2 1mgNETA 025mg E2 1mgNETA 05mg E2 2mgNETA 1mg

Endogenous hormones and risk of Hip amp

vertebral fractures among older women

Cummings et al NEJM1998

No Increase in Fractures After Stopping Hormone Therapy

Results From the Womens Health Initiative

bull Examine fractures after discontinuation of HT

bull 2 RCT (CEE+ MPA) CEE alone) WHI participants (N = 15187) who continued active HT or placebo through the intervention period and who did not take HT in the post-intervention period

bull Hip fractures were infrequent (sim25 1000 person-years) this finding was similar between trials and in former HT and placebo groups

bull CEE + MPA trial No difference in total fractures HR= 097 95 CI 087 -109 P = 063)

bull CEE-alone trial higher total fractures in former placebo users (3691000 person-years vs former active group 3111000 person-years) residual benefit of CEE (HR 085 95 CI 073 to 098 P = 003)

bull Watts et al J Clin Endocrinol Metab 2017 Jan 1102(1)302-308

Efficacy of 1mg E2 + 05mg NETA

on BMD

Adapted from McClung et al 1998

L1-L4 Femoral Neck Femoral Trochanter

0

2

4

6

-2

-4

BMD change af ter 26 months

placebo E2 025mg E2 05mg E2 1mg

E2 1mgNETA 025mg E2 1mgNETA 05mg E2 2mgNETA 1mg

Endogenous hormones and risk of Hip amp

vertebral fractures among older women

Cummings et al NEJM1998

No Increase in Fractures After Stopping Hormone Therapy

Results From the Womens Health Initiative

bull Examine fractures after discontinuation of HT

bull 2 RCT (CEE+ MPA) CEE alone) WHI participants (N = 15187) who continued active HT or placebo through the intervention period and who did not take HT in the post-intervention period

bull Hip fractures were infrequent (sim25 1000 person-years) this finding was similar between trials and in former HT and placebo groups

bull CEE + MPA trial No difference in total fractures HR= 097 95 CI 087 -109 P = 063)

bull CEE-alone trial higher total fractures in former placebo users (3691000 person-years vs former active group 3111000 person-years) residual benefit of CEE (HR 085 95 CI 073 to 098 P = 003)

bull Watts et al J Clin Endocrinol Metab 2017 Jan 1102(1)302-308

Endogenous hormones and risk of Hip amp

vertebral fractures among older women

Cummings et al NEJM1998

No Increase in Fractures After Stopping Hormone Therapy

Results From the Womens Health Initiative

bull Examine fractures after discontinuation of HT

bull 2 RCT (CEE+ MPA) CEE alone) WHI participants (N = 15187) who continued active HT or placebo through the intervention period and who did not take HT in the post-intervention period

bull Hip fractures were infrequent (sim25 1000 person-years) this finding was similar between trials and in former HT and placebo groups

bull CEE + MPA trial No difference in total fractures HR= 097 95 CI 087 -109 P = 063)

bull CEE-alone trial higher total fractures in former placebo users (3691000 person-years vs former active group 3111000 person-years) residual benefit of CEE (HR 085 95 CI 073 to 098 P = 003)

bull Watts et al J Clin Endocrinol Metab 2017 Jan 1102(1)302-308

No Increase in Fractures After Stopping Hormone Therapy

Results From the Womens Health Initiative

bull Examine fractures after discontinuation of HT

bull 2 RCT (CEE+ MPA) CEE alone) WHI participants (N = 15187) who continued active HT or placebo through the intervention period and who did not take HT in the post-intervention period

bull Hip fractures were infrequent (sim25 1000 person-years) this finding was similar between trials and in former HT and placebo groups

bull CEE + MPA trial No difference in total fractures HR= 097 95 CI 087 -109 P = 063)

bull CEE-alone trial higher total fractures in former placebo users (3691000 person-years vs former active group 3111000 person-years) residual benefit of CEE (HR 085 95 CI 073 to 098 P = 003)

bull Watts et al J Clin Endocrinol Metab 2017 Jan 1102(1)302-308

Routinely Asking Patients Dyspareunia is

Recommended

bull About 70 with vaginal dryness and dyspareunia

Reduction of quality of life

bull Recurrent Urinary tract Infection

Nappi RE et al Maturitas 2010 67233-8

HRT andor Vaginal Estrogen1

bull Systemic estrogen therapy (+ local ) vaginal tablets or creams

bull Estradiol Estriol CEE

bull Improvement of urge incontinence but not of Stress Incontinence

bull Moisturisers

bull Lubricants

bull Sexual therapy

bull hellipHRT Hormonal Replacement Therapy

CEE Conjugated Equine Estrogen1 Castelo-Branco C et al Maturitas 2005 52S S46-52

Not in favour

Perspective Menopause Management mdash

Getting Clinical Care Back on Track

JE Manson AM Kaunitz

N Engl J Med

March 3 2016

HRT andor Vaginal Estrogen1

bull Systemic estrogen therapy (+ local ) vaginal tablets or creams

bull Estradiol Estriol CEE

bull Improvement of urge incontinence but not of Stress Incontinence

bull Moisturisers

bull Lubricants

bull Sexual therapy

bull hellipHRT Hormonal Replacement Therapy

CEE Conjugated Equine Estrogen1 Castelo-Branco C et al Maturitas 2005 52S S46-52

Not in favour

Perspective Menopause Management mdash

Getting Clinical Care Back on Track

JE Manson AM Kaunitz

N Engl J Med

March 3 2016

Not in favour

Perspective Menopause Management mdash

Getting Clinical Care Back on Track

JE Manson AM Kaunitz

N Engl J Med

March 3 2016

Perspective Menopause Management mdash

Getting Clinical Care Back on Track

JE Manson AM Kaunitz

N Engl J Med

March 3 2016

Perspective Menopause Management mdash

Getting Clinical Care Back on Track

JE Manson AM Kaunitz

N Engl J Med

March 3 2016

Perspective Menopause Management mdash

Getting Clinical Care Back on Track

JE Manson AM Kaunitz

N Engl J Med

March 3 2016

Cumulative Annualized Incidence Rates for Clinical Outcomes in the WHI Estrogen-Alone Trial According to 10-Year Age Groups at Enrolment1

1 LaCroix A Z et al JAMA 20113051305-1314

Hodis et al NEJM 2016

Timing hypothesis amp window of opportunity

Young healthy woman

In favour of MHT

10 year risk

gt40

VTE

Postmenopausal Hormone Therapy and Risk of

Idiopathic Venous Thromboembolism Results From

the E3N Cohort Study

Canonico et al Arterioscler Thromb Vasc Biol 201030340-345

Perspective Menopause Management mdash

Getting Clinical Care Back on Track

JE Manson AM Kaunitz

N Engl J Med

March 3 2016

Hodis et al NEJM 2016

Timing hypothesis amp window of opportunity

Young healthy woman

In favour of MHT

10 year risk

gt40

VTE

Postmenopausal Hormone Therapy and Risk of

Idiopathic Venous Thromboembolism Results From

the E3N Cohort Study

Canonico et al Arterioscler Thromb Vasc Biol 201030340-345

Perspective Menopause Management mdash

Getting Clinical Care Back on Track

JE Manson AM Kaunitz

N Engl J Med

March 3 2016

Timing hypothesis amp window of opportunity

Young healthy woman

In favour of MHT

10 year risk

gt40

VTE

Postmenopausal Hormone Therapy and Risk of

Idiopathic Venous Thromboembolism Results From

the E3N Cohort Study

Canonico et al Arterioscler Thromb Vasc Biol 201030340-345

Perspective Menopause Management mdash

Getting Clinical Care Back on Track

JE Manson AM Kaunitz

N Engl J Med

March 3 2016

Young healthy woman

In favour of MHT

10 year risk

gt40

VTE

Postmenopausal Hormone Therapy and Risk of

Idiopathic Venous Thromboembolism Results From

the E3N Cohort Study

Canonico et al Arterioscler Thromb Vasc Biol 201030340-345

Perspective Menopause Management mdash

Getting Clinical Care Back on Track

JE Manson AM Kaunitz

N Engl J Med

March 3 2016

In favour of MHT

10 year risk

gt40

VTE

Postmenopausal Hormone Therapy and Risk of

Idiopathic Venous Thromboembolism Results From

the E3N Cohort Study

Canonico et al Arterioscler Thromb Vasc Biol 201030340-345

Perspective Menopause Management mdash

Getting Clinical Care Back on Track

JE Manson AM Kaunitz

N Engl J Med

March 3 2016

10 year risk

gt40

VTE

Postmenopausal Hormone Therapy and Risk of

Idiopathic Venous Thromboembolism Results From

the E3N Cohort Study

Canonico et al Arterioscler Thromb Vasc Biol 201030340-345

Perspective Menopause Management mdash

Getting Clinical Care Back on Track

JE Manson AM Kaunitz

N Engl J Med

March 3 2016

VTE

Postmenopausal Hormone Therapy and Risk of

Idiopathic Venous Thromboembolism Results From

the E3N Cohort Study

Canonico et al Arterioscler Thromb Vasc Biol 201030340-345

Perspective Menopause Management mdash

Getting Clinical Care Back on Track

JE Manson AM Kaunitz

N Engl J Med

March 3 2016

Postmenopausal Hormone Therapy and Risk of

Idiopathic Venous Thromboembolism Results From

the E3N Cohort Study

Canonico et al Arterioscler Thromb Vasc Biol 201030340-345

Perspective Menopause Management mdash

Getting Clinical Care Back on Track

JE Manson AM Kaunitz

N Engl J Med

March 3 2016

Perspective Menopause Management mdash

Getting Clinical Care Back on Track

JE Manson AM Kaunitz

N Engl J Med

March 3 2016

Perspective Menopause Management mdash

Getting Clinical Care Back on Track

JE Manson AM Kaunitz

N Engl J Med

March 3 2016

Variations in Associated Breast Cancer Risk Between CE alone and

CEMPA

Cumulative hazards

adjusted for age and

raceethnicity for

invasive breast cancer

by randomization

assignment in the WHI

CE-alone and CEMPA

trials

Anderson GL et al Lancet

Oncol 2012

00

1 2 3 4 5 6 7 8 9 10 11 12 13

001

002

003

004

005

Cu

mu

lati

ve

ha

za

rd

Time since randomization (years)

CEMPA

Placebo (in CEMPA arm)

HR 125 (95 CI 107ndash146)

CE alone

Placebo (in CE-alone arm)

HR 077 (95 CI 062ndash095)

CEMPA

CE alone

Placebo (CE-alone)

Placebo (CEMPA)

Variations in Associated Breast Cancer Risk Between CE alone and

CEMPA

Cumulative hazards

adjusted for age and

raceethnicity for

invasive breast cancer

by randomization

assignment in the WHI

CE-alone and CEMPA

trials

Anderson GL et al Lancet

Oncol 2012

00

1 2 3 4 5 6 7 8 9 10 11 12 13

001

002

003

004

005

Cu

mu

lati

ve

ha

za

rd

Time since randomization (years)

CEMPA

Placebo (in CEMPA arm)

HR 125 (95 CI 107ndash146)

CE alone

Placebo (in CE-alone arm)

HR 077 (95 CI 062ndash095)

CEMPA

CE alone

Placebo (CE-alone)

Placebo (CEMPA)

From Risk of breast cancer after stopping menopausal hormone

therapy in the E3N cohort Fournier A et al 2014

From Risk of breast cancer after stopping menopausal hormone

therapy in the E3N cohort Fournier A et al 2014

From Risk of breast cancer after stopping menopausal hormone

therapy in the E3N cohort Fournier A et al 2014

httpwwwems-

trialsorgriskevaluator

Variations in Associated Breast Cancer Risk Between CE alone and

CEMPA

Cumulative hazards

adjusted for age and

raceethnicity for

invasive breast cancer

by randomization

assignment in the WHI

CE-alone and CEMPA

trials

Anderson GL et al Lancet

Oncol 2012

00

1 2 3 4 5 6 7 8 9 10 11 12 13

001

002

003

004

005

Cu

mu

lati

ve

ha

za

rd

Time since randomization (years)

CEMPA

Placebo (in CEMPA arm)

HR 125 (95 CI 107ndash146)

CE alone

Placebo (in CE-alone arm)

HR 077 (95 CI 062ndash095)

CEMPA

CE alone

Placebo (CE-alone)

Placebo (CEMPA)

From Risk of breast cancer after stopping menopausal hormone

therapy in the E3N cohort Fournier A et al 2014

From Risk of breast cancer after stopping menopausal hormone

therapy in the E3N cohort Fournier A et al 2014

From Risk of breast cancer after stopping menopausal hormone

therapy in the E3N cohort Fournier A et al 2014

httpwwwems-

trialsorgriskevaluator

From Risk of breast cancer after stopping menopausal hormone

therapy in the E3N cohort Fournier A et al 2014

From Risk of breast cancer after stopping menopausal hormone

therapy in the E3N cohort Fournier A et al 2014

From Risk of breast cancer after stopping menopausal hormone

therapy in the E3N cohort Fournier A et al 2014

httpwwwems-

trialsorgriskevaluator

From Risk of breast cancer after stopping menopausal hormone

therapy in the E3N cohort Fournier A et al 2014

From Risk of breast cancer after stopping menopausal hormone

therapy in the E3N cohort Fournier A et al 2014

httpwwwems-

trialsorgriskevaluator

From Risk of breast cancer after stopping menopausal hormone

therapy in the E3N cohort Fournier A et al 2014

httpwwwems-

trialsorgriskevaluator

httpwwwems-

trialsorgriskevaluator

Perspective Menopause Management mdash

Getting Clinical Care Back on Track

JE Manson AM Kaunitz

N Engl J Med

March 3 2016

What if there is a

contraindication for MHT

Copyright restrictions may applyNelson H D et al JAMA 20062952057-2071

Metaanalysis of Clonidine

4 weeks

8 weeks

Forest plots of hot flash reduction in newer antidepressant studies

Loprinzi C L et al JCO 2009272831-2837

copy2009 by American Society of Clinical Oncology

Metaanalysis of gabapentin

Loprinzi 2009

Copyright restrictions may applyNelson H D et al JAMA 20062952057-2071

Metaanalysis of Clonidine

4 weeks

8 weeks

Forest plots of hot flash reduction in newer antidepressant studies

Loprinzi C L et al JCO 2009272831-2837

copy2009 by American Society of Clinical Oncology

Metaanalysis of gabapentin

Loprinzi 2009

Forest plots of hot flash reduction in newer antidepressant studies

Loprinzi C L et al JCO 2009272831-2837

copy2009 by American Society of Clinical Oncology

Metaanalysis of gabapentin

Loprinzi 2009

Metaanalysis of gabapentin

Loprinzi 2009

Cognitive Function

bull estrogen neuroprotective

bull Animal data estrogen enhancement of synaptic plasticity and reduced production of β-amyloid the protein associated with Alzheimer disease development

bull Neuroimaging studies in humans suggest that estrogen enhances brain activity related to memory processing

bull no data exist showing direct cognitive benefits of HRT in young women with POI

Premature and early

menopause

bull Premature (before 40 years) and early menopause (before 45 years) whether natural or induced is associated with increased morbidity amp mortality when women are untreated with MHT

bull Several recent meta-analyses reported in particular increased cardiovascular morbi-mortality (Grade 1C)

bull Muka T et al JAMA Cardiol 2016

Key points

bull Postmenopausal hormone therapy (PMHT) is indicated for the relief of menopausal symptoms in patients aged with climacteric symptoms

bull Low doses of PMHT should be used when possible

bull PMHT can be prescribed to treat osteoporosis when non-oestrogen therapies are unsuitable or in women who suffer simultaneously from climacteric symptoms and osteoporosis

bull Postmenopausal hormone therapy risks and benefits Rozenberg S

Vandromme J Antoine C Nat Rev Endocrinol 2013 Feb 19

Premature and early

menopause

bull Premature (before 40 years) and early menopause (before 45 years) whether natural or induced is associated with increased morbidity amp mortality when women are untreated with MHT

bull Several recent meta-analyses reported in particular increased cardiovascular morbi-mortality (Grade 1C)

bull Muka T et al JAMA Cardiol 2016

Key points

bull Postmenopausal hormone therapy (PMHT) is indicated for the relief of menopausal symptoms in patients aged with climacteric symptoms

bull Low doses of PMHT should be used when possible

bull PMHT can be prescribed to treat osteoporosis when non-oestrogen therapies are unsuitable or in women who suffer simultaneously from climacteric symptoms and osteoporosis

bull Postmenopausal hormone therapy risks and benefits Rozenberg S

Vandromme J Antoine C Nat Rev Endocrinol 2013 Feb 19

Key points

bull Postmenopausal hormone therapy (PMHT) is indicated for the relief of menopausal symptoms in patients aged with climacteric symptoms

bull Low doses of PMHT should be used when possible

bull PMHT can be prescribed to treat osteoporosis when non-oestrogen therapies are unsuitable or in women who suffer simultaneously from climacteric symptoms and osteoporosis

bull Postmenopausal hormone therapy risks and benefits Rozenberg S

Vandromme J Antoine C Nat Rev Endocrinol 2013 Feb 19

Key points bull PMHT for Prevention of coronary heart disease

bull Oestrogen therapy might reduce the risk of atherosclerosis in young women early after menopause but risk of coronary heart disease might be worsened as a result of thrombosis in at-risk and elderly patients

bull PMHT may increase Breast cancer risk

bull Use of a estrogen only (hysterectomized women) sequential progestin and a non-androgenic progestin might be safer than use of continuous androgenic progestin

bull Short term entails less or no risk

bull long-term EPT containing progestagens other than progesterone or dydrogesterone may be associated with some residual risk even many years after treatment cessation

bull Postmenopausal hormone therapy risks and benefits Rozenberg S Vandromme J Antoine C Nat Rev Endocrinol 2013 Feb 19