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Title of Journal: J Obstet Gynecol India

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Abbravation: The Journal of Obstetrics and Gynecology of India

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Hormone Replacement Therapy: An Update

Authors: Suvarna Khadilkar,

Publish Date: 2012/08/21
Volume: 62, Issue:3, Pages: 261-265
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Ever since menopause was causally linked to several symptoms and disease processes, the concept of hormone replacement therapy (HRT) took root and was widely practiced over half a century. We have witnessed the rise and fall of the HRT during these years. While the life expectancy has improved enormously, the average age of menopause has not changed, and hence a vast majority of women spend one third of their lives in the state of estrogen deficiency. The long-term problems of menopause, therefore, are important to the present times.It is rather interesting to study the changing trends in hormonal management of menopause. There was a time when menopause was managed without hormones because of lack of knowledge. This was followed by selective use of HRT and then the wide and universal use of HRT, only to realize the emergence of health risks related to HRT. Hence, the approach had to be changed again. After having gone through these changes, we seem to have completed the cycle and stand at a point not far away from where we began, but with a lot of knowledge and conclusions.The WHI trial enrolled approximately 16,000 women nationwide, from the ages of 50–79 years. The average age of women in the study was 63 years. The major goal of the WHI clinical trial was to determine whether combined estrogen and progestin HRT prevented heart disease and fractures, and whether there were associated risks. After an average of 5 years of follow-up, heart disease and stroke were significantly increased in HRT users by 29 and 41 %, respectively. Venous thromboembolic events (VTEs) were increased twofold. Approximately 11,000 women without a uterus participated in a separate WHI study [2] and were randomized either to estrogen alone or to placebo. After an average follow-up of 7 years, there was no increased risk of heart disease in estrogen users. Estrogen use did have adverse vascular effects, increasing the risk of stroke by 39 % and VTEs by 33 %.Menopause practitioners stopped prescribing HRT. Women who were already on the HRT discontinued the therapy. And a wave of fear about HRT spread across the globe. A decade has passed since the WHI reports were published. Even though the practice of universal HRT has not resumed, HRT today has a definite role in management of menopause. This editorial will focus upon health concerns after menopause and the place of HRT today.Hot flashes are the primary reason women seek care at menopause and request hormone therapy. Systemic estrogen therapy is the most effective treatment available for vasomotor symptoms and the associated sleep disturbance. If cessation of HRT is desired, it is important to reduce the dose slowly over several months. When a woman chooses not to take estrogen or when it is contraindicated, progestin therapy alone is an option. Medroxyprogesterone acetate [3] (MPA) and megestrol acetate [4] effectively treat vasomotor symptoms. Several drugs that alter central neurotransmitter pathways, selective serotonin reuptake inhibitors and other antidepressants, also are effective.



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