Using a case history of a patient with classical menopausal symptoms, Martin and Manson have recently reviewed in brief the recent data and controversies over hormone replacement therapy (HRT) and discussed hormonal regimens (oral, transdermal) and dosage, duration of therapy and alternative treatment options [1]. The main motif of the article is safety, namely, how to balance the potential benefits of HRT against the potential risks in early and late menopause, and ways to identify patients in whom this balance would be the most, or least, favorable. For example, the authors suggest to incorporate the Framingham Score (a tool for assessment of the 10-year risk for coronary heart disease) in decision-making and consider a cut-off point of higher than 20% risk in the first 5 years of menopause, or higher than 10% risk during years 6–10 after menopause as a negative argument for prescribing HRT.
Author(s)
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Amos Pines
Department of Medicine T, Ichilov Hospital, Tel-Aviv, Israel
Citations
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Martin KA, Manson JE. Approach to the patient with menopausal symptoms. J Clin Endocrinol Metab 2008;93:4567-75. Published December 2008.
http://www.ncbi.nlm.nih.gov/pubmed/19056840 -
Utian WH, Archer DF, Bachmann GS, et al. Estrogen and progestogen use in postmenopausal women: July 2008 position statement of the North American Menopause Society. Menopause 2008;15:584602. Published July/August 2008.
http://www.ncbi.nlm.nih.gov/pubmed/18580541 -
Practice Committee of the American Society for Reproductive Medicine. Estrogen and progestogen therapy in postmenopausal women. Fertil Steril 2008;90(Suppl 5):S88102. Published November 2008.
http://www.ncbi.nlm.nih.gov/pubmed/19007655 -
American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. ACOG Committee Opinion No. 420, November 2008: hormone therapy and heart disease. Obstet Gynecol 2008;112:118992. Published November 2008.
http://www.ncbi.nlm.nih.gov/pubmed/18978127 -
Gompel A, Rozenberg S, Barlow DH, et al. The EMAS 2008 update on clinical recommendations on postmenopausal hormone replacement therapy. Maturitas 2008;61:22732. Published November 20, 2008.
http://www.ncbi.nlm.nih.gov/pubmed/19028033 -
Board of the International Menopause Society, Pines A, Sturdee DW, Birkhäuser MH, et al. IMS updated recommendations on postmenopausal hormone therapy. Climacteric 2007;10:18194. Published June 2007.
http://www.ncbi.nlm.nih.gov/pubmed/17487645
