Many women of a certain age wonder if they are candidates for hormone therapy (HT) and seek advice and treatment from their doctors. As of this month, those doctors may share information based on new guidelines from the North American Menopause Society (NAMS).
"There are some important changes from guidelines that have been used for the past few years," said Maxine Lingurar, M.D., who practices at the Women’s Health Center at St. Rose Ambulatory & Surgery Center. "For instance, we now know there are important differences in a woman’s HT risks, depending on age, other health conditions, and the type and duration of therapy.
"It is now thought," Dr. Lingurar continued, "that for most women in the early stages of menopause, it is relatively safe to use short-term HT to relieve symptoms when they are most severe. For women older than 60, the risks are generally thought to increase."
Many women who have had a hysterectomy may be treated with estrogen alone, instead of having to take a progestin, Dr. Lingurar said. "Estrogen therapy does not seem to carry the same increased risk of breast cancer that estrogen with progestin therapy does," she explained. "That means estrogen alone can be prescribed for a longer duration in many cases."
One of the most confusing areas of HT involves the term "bioidentical." NAMS clarifies its position on this issue, recommending that unless there is a true allergy to FDA-approved bioidentical hormones, custom-compounded hormones should not be prescribed.
Custom-compounded hormones are made at compounding pharmacies; they are not approved by the Food and Drug Administration and have not been tested for effectiveness, safety, dose accuracy or purity, Dr. Lingurar said.
The St. Rose physician and her colleague, Julie McClaren, ARNP, are members of NAMS. Dr. Lingurar is a NAMS-certified menopause practitioner and McClaren will earn certification this spring.
They noted that NAMS is the premier nonprofit organization dedicated to the study of menopause and all related health issues.
"Its guidelines are written and reviewed by a multi-disciplinary panel of the world’s experts in the care of menopausal women," McClaren commented. "These recommendations represent the most current sound scientific knowledge available."
Dr. Lingurar and McClaren noted a summary of NAMS guidelines:
• HT remains the most effective treatment available for menopausal symptoms, including hot flashes and night sweats that can interrupt sleep and impair quality of life. Many women can take it safely.
• Those with a history of blood clots, heart disease, stroke or breast cancer, may not be able to take HT.
• The amount of time a patient can take estrogen and progestin is limited by the increased risk of breast cancer, which is seen with more than three to five years of use. With estrogen only, there was no sign of an increased risk of breast cancer during an average of seven years of treatment.
• Most healthy women under 60 will have no increase in heart-disease risk with HT. The risks of stroke and blood clots in the lungs increase but the risk is less than 1 in every 1,000 women per year taking HT.
• Estrogen delivered through the skin by patch, cream, gel or spray, and low-dose oral estrogen may have lower risks of blood clots and stroke than standard doses of oral estrogen.
For further information, Dr. Lingurar suggests visiting the NAMS website, www.menopause.org.
"This site has a wealth of information not only on HT, but also bone health, sexual health and non-hormonal treatments for menopause symptoms," Dr. Lingurar said. "And, of course, women should discuss their questions with their healthcare providers to get personalized recommendations."
