Have you had the HRT talk yet? New review says docs should pipe up more about menopause symptoms and treatments

Doctors need to be more proactive in discussing symptoms and treatment options with female patients going through menopause transition, and should consider hormone replacement therapy (HRT) as a first-line treatment for patients without risk factors. This was among the key recommendations from a review of the current literature on menopause symptoms, diagnosis and treatment conducted by researchers from Toronto-based Women’s College Hospital, University of Toronto, Unity Health Toronto and Queen’s University in Kingston, Ont., published in the Canadian Medical Association Journal. “Based on research and also what I’ve seen in my own clinical practice, very rarely are women asked about menopausal symptoms or offered any treatment, let alone hormone therapy for their menopause symptoms,” research co-author Dr. Iliana Lega, an endocrinologist at Women’s College Hospital and scientist at the Women’s College Research Institute, told the Medical Post. “There’s not enough conversation happening even in the clinician’s office. That’s really the issue here.” The lack of conversation is often the result of physicians failing to bring up the subject, which Dr. Lega said they should start doing when a patient enters perimenopause. But patients are also reluctant to start the discussion, in part because they don’t feel comfortable talking about menopause and its symptoms. “There’s also the pervasive misconception that there aren't any safe treatments because of all the conflicting information around hormone therapy,” said Dr. Lega. “So patients don't think it's worth bringing up.” Read: Hormone therapy safety in breast cancer survivors For many, the concerns around HRT are based on findings from the Women’s Health Initiative Trial—released in the early 2000s—which suggested a link between HRT and an increased risk of cardiovascular events. But more and more evidence shows a “possible reduction in coronary artery disease with menopausal hormone therapy among younger menopausal patients, specifically those who start menopausal hormone therapy before age 60 years or within 10 years of menopause," the authors wrote. The research notes the Society of Obstetricians and Gynaecologists of Canada and the North American Menopause Society both recommend menopausal hormone therapy as the first-line treatment for vasomotor symptoms for both menopausal and perimenopausal patients. “The estrogen component of menopausal hormone therapy reduces bothersome menopausal symptoms, while the progestin protects the endometrium from hyperplasia and reduces the risk of endometrial cancer,” the authors wrote. “Treatment with combined estrogen and progestin regimens (or estrogen alone, in patients who have had a hysterectomy) reduces the frequency and severity of hot flashes and night sweats by around 75%.” Menopausal hormone treatment can improve vasomotor symptoms—by as much as 90% in patients with moderate-to-severe hot flashes. It also improves quality and mood disturbances, said the report. Read: Dying to be seen: Why women’s risk for heart disease and stroke is still higher than men’s in Canada While HRT can help with menopause-related genitourinary syndrome, patients being treated primarily for this issue could also be addressed effectively with just lubricants, moisturizers, vaginal estrogens or oral selective estrogen receptor modulators. Physicians should also consider non-hormonal options when HRT isn’t appropriate because of contraindications or a patient’s preference. These options include certain selective serotonin reuptake inhibitors, serotonin–norepinephrine reuptake inhibitors, clonidine, oxybutynin and gabapentinoids. The latter are particularly useful when taken at night to help alleviate nocturnal symptoms, wrote the authors. A new class, awaiting approval, is the neurokinin-3 receptor antagonist, which acts to stabilize the temperature control centre in the hypothalamus. While the review findings still leave many unanswered questions—such as the optimal duration of hormone therapy or optimal formulations for cardiovascular—Dr. Lega said she and her co-authors hope their report will nudge doctors to bring up the often-uncomfortable subject of menopause. “Our message is, ‘let’s make sure we have this discussion and not overlook HRT as a first-line treatment,” she said. Read: Timing of menopausal hormone therapy important in terms of CVD risks

Have you had the HRT talk yet? New review says docs should pipe up more about menopause symptoms and treatments

Register for free access or login.

Related Topics