“The risks of HT differ for different women, depending on type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is needed”.1

Umbrella
What may the Hormone Therapy Risks Umbrella include?

Depending on the Source (DotS) this Umbrella may include:

  • Hormone Replacement Therapy (HRT) Risks
  • Hormone Therapy (HT) Risks
  • Menopausal Hormone Therapy (MHT) Risks

Date

What can it be important to be clear about with hormone therapy (HT) risks information?

I think it can be important to be clear about the date of all information including the date of HT risks information, because this information may have been updated.

Symptoms or Chronic Conditions

What can it also be important to be clear about with HT risks information?

I think it can also be important to be clear about whether HT risks information is about the use of HT for the management of menopausal symptoms such as hot flushes, night sweats and vaginal dryness or for the prevention of chronic conditions such as cardiovascular disease, cancer and osteoporosis.

Estrogen Plus Progestogen and Estrogen Therapy

Can the risks of HT differ for Estrogen Plus Progestogen (EPT) and Estrogen Therapy (ET)?

Yes.

Uterus or No UterusHormone Therapy Risks

Can the risks of differ for women who have a uterus and women who do not a uterus?

Yes.

Different Differences

What are some other HT risks differences?

On page one in the NAMS 2017 Position Statement Updates Guidelines for Hormone Therapy Use the North American Menopause Society (NAMS) elaborate on:

  • “The risks of HT differ for different women, depending on type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is needed. Treatment should be individualized using the best available evidence to maximize benefits and minimize risks, with periodic reevaluation for the benefits and risks of HT continuation”.2

Risk and Benefits

Are HT risks small and usually outweighed by the benefits?

In Hormone Replacement Therapy (HRT): Risks the (United Kingdom) NHS (National Health Service) note:

“Many studies on HRT that have been published over the past 15 years highlight the potential risks. As a result, some women and doctors have been reluctant to use HRT.

But more recent evidence says that the risks of HRT are small and are usually outweighed by the benefits”.3

NICE Guidelines

What did the (British) National Institute for Health and Care Excellence’s (NICE) guidelines note about the benefits and risks of hormone replacement therapy (HRT)?

In Menopause: Diagnosis and Management – Information for the Public: Benefits and Risks of HRT the NICE explain and elaborate on:

“NICE looked at the risks of the following conditions in women taking HRT compared with women of menopausal age in the general population. Your GP should explain that the risks of the conditions described below vary from one woman to another and depend on many risk factors. In cases where HRT is said to increase risk this usually means a very small increase in most women.

  • Blood Clots (Venous Thromboembolism)…
  • Heart Disease and Stroke (Cardiovascular Disease)…
  • Breast Cancer…
  • Type 2 Diabetes…
  • Osteoporosis…
  • Loss of Muscle Strength…
  • Dementia…”.4

Revised Global Consensus Statement

What is one of the points of consensus about menopausal hormone therapy (MHT) and risk?

One of the points of consensus in the Revised Global Consensus Statement on Menopausal Hormone Therapy: Section A: Benefit/Risk Profile of MHT – endorsed by seven menopause-related organizations – published online 20 June 2016, is:

  • “MHT, including tibolone and the combination of conjugated equine estrogens and bazedoxifene (CE/BZA), is the most effective treatment for vasomotor symptoms (VMS) associated with menopause at any age, but benefits are more likely to outweigh risks if initiated for symptomatic women before the age of 60 years or within 10 years after menopause”.5


What are vasomotor symptoms?

The International Menopause Society explain:

“Hot flushes and night sweats are also referred to as Vasomotor Symptoms (VMS)”.6

Before Age 60

Before age 60, can age and time since menopause matter?

On page one in the NAMS 2017 Position Statement Updates Guidelines for Hormone Therapy Use the NAMS note:

  • “For women aged younger than 60 years or who are within 10 years of menopause onset and have no contraindications, the benefit-risk ratio appears favorable for treatment of bothersome hot flashes and for those at elevated risk of bone loss or fracture. Longer duration may be more favorable for estrogen-alone therapy than for estrogen-progestogen therapy, based on the Women’s Health Initiative randomized, controlled trials”.7

On page one in Deciding About Hormone Therapy Use: Potential Risks published in June 2017, the NAMS also explain:

“As with all medications, HT is associated with some potential risks. For healthy women aged younger than 60 years with bothersome hot flashes who are within 10 years of menopause, the benefits of HT generally outweigh the risks. Hormone therapy might slightly increase your risk of stroke or blood clots in the legs or lungs (especially if taken in pill form)”.8

After Age 60

After age 60, can age and time since menopause matter?

On page one in the NAMS 2017 Position Statement Updates Guidelines for Hormone Therapy Use the NAMS note:

Hormone Therapy Risks

  • “For women who initiate HT more than 10 or 20 years from menopause onset or when aged 60 years or older, the benefit -risk ratio appears less favorable than for younger women because of greater absolute risks of coronary heart disease, stroke, venous thromboembolism, and dementia”.9

On page one in Deciding About Hormone Therapy Use: Potential Risks the NAMS also explain:

“If started in women aged older than 65 years, HT might increase the risk of dementia. If you have a uterus and take estrogen with progestogen, there is no increased risk of cancer of the uterus. Hormone therapy (combined estrogen and progestogen) might slightly increase your risk of breast cancer if used for more than 4 to 5 years. Using estrogen alone (for women without a uterus) does not increase breast cancer risk at 7 years but may increase risk if used for a longer time”.10

At Risk

What are some contraindications to taking HT?

In Menopause Management: Menopausal Hormone Therapy (MHT) – Contraindications To Taking MHT the (Australian) Jean Hailes for Women’s Health (JH) elaborate on these and more contraindications:

  • “Current, past or suspected breast cancer/li>
  • Known or suspected oestrogen-dependent cancer, such as breast and uterine cancers/li>
  • Undiagnosed vaginal bleeding/li>
  • Untreated uterine lining thickening, which could develop into cancer/li>
  • Current thrombosis or DVT (deep vein thrombosis), but a past history would require further investigation to establish if MHT is safe
  • Thrombophilia (a group of conditions that lead to an increased risk of thrombosis)…”.11

Do Not Take

Which women should not take HT?

In Menopause: Medicines To Help You the (United States) Food and Drug Administration elaborate on:

“Do not take hormone therapy if you:

  • Have problems with vaginal bleeding
  • Have or have had certain cancers such as breast cancer or uterine cancer
  • Have or have had a blood clot, stroke or heart attack
  • Have a bleeding disorder
  • Have liver disease
  • Have allergic reactions to hormone medicine”.12

Health Care Provider

If I choose to take HT, how may I find out what my risks are?

If you choose to take HT, it may be in your best interest to also choose to ask your health care provider about this.

One of the points of consensus in the Revised Global Consensus Statement on Menopausal Hormone Therapy: Section B: General Principles Governing the Use of MHT is:

Hormone Therapy Risks

  • “The option of MHT is an individual decision in terms of quality of life and health priorities as well as personal risk factors such as age, time since menopause and the risk of VTE, stroke, ischemic heart disease and breast cancer. MHT should not be recommended without a clear indication for its use”.13

What is VTE?

VTE can be an abbreviation for Venous Thromboembolism.

In Hormone Replacement Therapy (HRT): Risks the NHS elaborate on:

“When deciding whether to have hormone replacement therapy (HRT), it’s important to understand the risks.

It’s also important to consider HRT as only 1 of a range of options to improve menopausal and postmenopausal health and wellbeing”.14

On page one in Deciding About Hormone Use the NAMS explain:

“Every woman is different—and you must make a decision about whether to use HT based on the severity of your symptoms, your personal and family health history, and your own beliefs about menopause treatments. Your healthcare provider will be able to help you with your decision”.15

In Menopause Management: Menopausal Hormone Therapy (MHT) – Should You Take MHT? the JH include:

  • “Jean Hailes recommends each woman discusses her decision about taking MHT with her doctor regularly and whenever there are any concerns”.16

In Menopause: Diagnosis & Treatment – Treatment: Hormone Therapy the (United States) Mayo Clinic note:

“Before deciding on any form of treatment, talk with your doctor about your options and the risks and benefits involved with each. Review your options yearly, as your needs and treatment options may change”.17

Health Topics A-Z

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Links

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Sources

Where may I find the Sources quoted?

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Sources

  1. NAMS 2017 Position Statement Updates Guidelines for Hormone Therapy Use. 20 June 2017:1. North American Menopause Society https://www.menopause.org/docs/default-source/default-document-library/ht-press-release-061917.pdf Accessed: 16 October 2020
  2. NAMS 2017 Position Statement Updates Guidelines for Hormone Therapy Use. 20 June 2017:1. North American Menopause Society https://www.menopause.org/docs/default-source/default-document-library/ht-press-release-061917.pdf Accessed: 16 October 2020
  3. Hormone Replacement Therapy (HRT): Risks. Page Last Reviewed: 09 September 2019. NHS (National Health Service) https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/risks/ Accessed: 16 October 2020
  4. Menopause: Diagnosis and Management – Information for the Public: Benefits and Risks of HRT. Published Date: 12 November 2015. Last Updated: 05 December 2020. National Institute for Health and Care Excellence https://www.nice.org.uk/guidance/ng23/ifp/chapter/Benefits-and-risks-of-HRT Accessed: 16 October 2020
  5. De Villiers, T. J., Hall, J. E., Pinkerton, J. V., Pérez, S. C., Rees, M., Yang, C. and Pierroz, D. D. Revised Global Consensus Statement on Menopausal Hormone Therapy: Section A: Benefit/Risk Profile of MHT. Climacteric, 2016;19:4:313 https://www.imsociety.org/manage/images/pdf/ba6379e868044bec13015ac2b84f2753.pdf Accessed: 16 October 2020
  6. Hot Flushes and Night Sweats – Background Information: What Are Hot Flushes and Night Sweats? October 2011:1. International Menopause Society https://www.imsociety.org/downloads/world_menopause_day_2011/wmd_media_backgrounder.pdf Accessed: 16 October 2020
  7. NAMS 2017 Position Statement Updates Guidelines for Hormone Therapy Use. 20 June 2017:1. North American Menopause Society https://www.menopause.org/docs/default-source/default-document-library/ht-press-release-061917.pdf Accessed: 16 October 2020
  8. Deciding About Hormone Therapy Use: Potential Risks. 2017:1. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/menonote-deciding-about-ht-2017.pdf Accessed: 16 October 2020
  9. NAMS 2017 Position Statement Updates Guidelines for Hormone Therapy Use. 20 June 2017:1. North American Menopause Society https://www.menopause.org/docs/default-source/default-document-library/ht-press-release-061917.pdf Accessed: 16 October 2020
  10. Deciding About Hormone Therapy Use: Potential Risks. 2017:1. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/menonote-deciding-about-ht-2017.pdf Accessed: 16 October 2020
  11. Menopause Management: Menopausal Hormone Therapy (MHT): Contraindications To Taking MHT. Last Updated: 30 July 2020 | Last Reviewed: 17 December 2017. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management/ Accessed: 16 October 2020
  12. Menopause: Medicines To Help You. Content Current As of: 22 August 2019. Food and Drug Administration https://www.fda.gov/ForConsumers/ByAudience/ForWomen/ucm118627.htm Accessed: 16 October 2020
  13. De Villiers, T. J., Hall, J. E., Pinkerton, J. V., Pérez, S. C., Rees, M., Yang, C. and Pierroz, D. D. Revised Global Consensus Statement on Menopausal Hormone Therapy: Section B: General Principles Governing the Use of MHT. Climacteric, 2016;19:4:314 https://www.imsociety.org/manage/images/pdf/ba6379e868044bec13015ac2b84f2753.pdf Accessed: 16 October 2020
  14. Hormone Replacement Therapy (HRT): Risks. Page Last Reviewed: 09 September 2019. NHS (National Health Service) https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/risks/ Accessed: 16 October 2020
  15. Deciding About Hormone Therapy Use. 2017:1. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/menonote-deciding-about-ht-2017.pdf Accessed: 16 October 2020
  16. Menopause Management: Menopausal Hormone Therapy (MHT): Should You Take MHT? Last Updated: 30 July 2020 | Last Reviewed: 17 December 2017. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management/ Accessed: 16 October 2020
  17. Menopause: Diagnosis & Treatment – Treatment: Hormone Therapy. 14 October 2020. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/menopause/diagnosis-treatment/drc-20353401 Accessed: 16 October 2020

Topic Last Updated: 16 October 2020 – Topic Last Reviewed: 16 October 2020
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