Hormone replacement therapy should be first-line treatment for menopausal women under 60, study says

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West Virginia University students Elle Diden, Leah Farrell, and Bri Kayson demonstrate the medical procedures required for hormone replacement therapy on March 8 in Morgantown, West Virginia.Kathleen Batten/Associated Press

Hormone replacement therapy should be the first treatment offered to women under the age of 60 who suffer from hot flashes, night sweats and other symptoms of menopause, according to a review of the scientific literature released Monday.

The new study, published in the Canadian Medical Association Journal, strengthens changes already underway. Hormone replacement therapy (HRT), once considered too risky for most women, is now back in favor of many physicians, with a seminal study 20 years ago showing: They argue that the risks of treatment, especially for young women, were exaggerated.

“At the time, 20 years ago, there was a lot less prescription for hormone therapy, and there was a lot of fear,” says an endocrinologist at Toronto’s Women’s College Hospital and one of the authors of the new paper. As one Ileana Lega said: . “Frankly, what has happened in the medical community is that there is a real lack of education.

Dr. Rega and co-authors synthesized evidence from all studies on the subject published in medical journal databases by last April, and conducted a peer review that included brief recommendations for other physicians to address the issue. I would like to contribute to the correction of

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Their conclusion is that HRT can be offered as the first choice for women addressing menopausal symptoms, unless the patient is younger than 60 years of age, or less than 10 years since their last menstrual period, and has specific risk factors such as a medical history. It should have been. Breast cancer, coronary artery disease, stroke, etc.

This is consistent with recent recommendations from major medical societies such as the Canadian College of Obstetrics and Gynecology, the Canadian Menopause Society, and the North American Society of Menopause.

“For many women, this is a huge problem,” said Wendy Wolfman, director of the Menopause and Premature Ovarian Dysfunction Clinic at Mount Sinai Hospital in Toronto. She was not involved in new research.

“This is also a problem for our society because women reach their peak productivity at the same time they are symptomatic. cannot progress with

Menopause, defined as one year after a woman’s last menstrual period, is characterized by symptoms leading up to and after the milestone (hot flashes, night sweats, sleep disturbances, mood swings, foggy head, dry vagina). etc.) may last up to 10 years. When estrogen levels drop.

Michelle Jacobson, a menopausal specialist at Women’s University and another author of the new study, said some women don’t seek treatment because they think their symptoms are tolerable. However, some experience a debilitating illness.

“Some studies have tried to compare and quantify the effect of symptoms,” Dr. Jacobson said. “For some women, this is as bad as kidney failure and having to go on dialysis.” clarified.)

Hormone replacement therapy is a drug therapy that consists of a combination of estrogen or progestin, a synthetic form of estrogen and progesterone. This treatment was widely prescribed for him until 2002, when the first results of a large randomized controlled trial called the Women’s Health Initiative dealt a dying blow to his HRT.

The trial, which involved more than 27,000 women, aimed to see if HRT could help prevent chronic diseases in women aged 50 to 79. However, the researchers overseeing the trial found the opposite to be true and stopped it early. HRT participants had more symptoms. Fewer breast cancers, blood clots, heart disease, and stroke than those taking placebo.

Women in the HRT arm of the trial also had fewer cases of colorectal cancer and hip fractures, but the risks of HRT appeared to outweigh the benefits. An HRT prescriber fell off a cliff.

Since then, the first reanalysis and follow-up of the WHI data has focused on differences in how women under 60 (or less than 10 years postmenopausal) and over 60 years of age receive HRT. I was. These studies found that the benefits of reducing hot flashes, night sweats, and other menopausal symptoms outweighed the risks when healthy women started taking it at the appropriate age.

Some organizations remain wary of HRT. For example, the Canadian Cancer Society recommends that “women avoid taking HRT for any reason other than to relieve symptoms of severe menopause that have failed other treatments.” The society says that if HRT is chosen, it should be taken at the lowest dose for the shortest possible period.

However, Canadian Cancer Society spokeswoman Michelle Bilton said the statement was being considered.

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