Postmenopausal hormone therapy

BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39188.594282.80 (Published 26 April 2007) Cite this as: BMJ 2007;334:860
  1. Deborah Grady, professor of medicine1,
  2. Elizabeth Barrett-Connor, professor and chief2
  1. 1University of California, San Francisco and San Francisco VA Medical Center, San Francisco, CA 94115, USA
  2. 2Division of Epidemiology, Department of Family and Preventive Medicine, University of California, San Diego School of Medicine, San Diego, California, 92093, USA
  1. Deborah.Grady{at}ucsf.edu

    Symptoms should be treated with lowest effective dose of hormone therapy for the shortest time possible

    In March 2007, the North American Menopause Society (NAMS) published an updated position statement on the use of hormone therapy in postmenopausal women.1 NAMS recommends hormone therapy, which is a highly effective treatment for hot flushes and vaginal atrophy,2 as first line treatment for women with moderate to severe symptoms. It is also effective for preventing osteoporotic fractures,3 4 but NAMS recommends that hormone therapy for this purpose should be weighed against potential harm and that other approved preventive treatments such as bisphosphonates should be considered. These recommendations are clear, simple, and based on solid evidence from many randomised controlled trials.

    However, NAMS recommendations are less clear in several other areas. For example, after clearly stating that hormone therapy increases risk of venous thromboembolic events and stroke, no advice is provided about how clinicians and patients should use this information. Similarly, NAMS notes that risk of breast cancer …

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