Menopause Hormone Therapy: 2023 Update

Authors

  • Denise Black, MD Department of Obstetrics and Gynecology, University of Manitoba

DOI:

https://doi.org/10.58931/cpct.2023.1320

Abstract

The publication of the Women’s Health Initiative (WHI) study in 2002 caused a precipitous decline in use of menopause hormone therapy (MHT). Prior to publication, approximately 43% of women aged 45–74 used MHT; following publication, this number dropped to 11%. Fear of breast cancer was the largest motivator behind this decline. Since the WHI study, menopause medical education has been inadequate; it is estimated that 41% of medical schools do not include menopause education in their undergraduate curriculum. The same study highlighted significant knowledge gaps regarding menopause management among practicing physicians.

Menopausal women are asking questions and expecting answers. Advocacy groups such as the Menopause Foundation of Canada are empowering women to acknowledge the impact of menopausal symptoms on the workplace, personal relationships and personal health. As MHT is considered first-line therapy (in the absence of contraindications), it behooves healthcare providers to have a working knowledge of MHT.

Author Biography

Denise Black, MD, Department of Obstetrics and Gynecology, University of Manitoba

Dr. Denise Black is a graduate of the University of Manitoba School of medicine and she completed residency training in OB/GYN in Manitoba as well. In a career that spans 4 decades, she has been involved in both the academic and private practice. While in academia, Dr. Black served as the Director of the post graduate medical education program in Obstetrics and Gynecology and served as an examiner for the Royal College. She also was the OB/GYN consultant for the Manitoba HIV team during the early years when intrapartum AZT was first introduced as a way to reduce vertical transmission. Access to appropriate and timely contraceptive care is a professional passion, and advocacy, education, and removing barriers to access is a personal mission. Dr. Black has published in both the fields of contraception and menopause and worked as an author of the SOGC menopause guidelines.

References

Langer RD, Hodis HN, Lobo RA, Allison MA. Hormone replacement therapy–where are we now? Climacteric. 2021 Jan 2;24(1):3-10. DOI: https://doi.org/10.1080/13697137.2020.1851183

Armeni E, Mili N, Siliogka E, Goulis DG, Lambrinoudaki I. Menopause medical education around the world: the way forward to serve women’s health. Current Opinion in Endocrine and Metabolic Research. 2022 Aug 5:100387. DOI: https://doi.org/10.1016/j.coemr.2022.100387

Yuksel N, Evaniuk D, Huang L, Malhotra U, Blake J, Wolfman W, Fortier M. Guideline no. 422a: menopause: vasomotor symptoms, prescription therapeutic agents, complementary and alternative medicine, nutrition, and lifestyle. Journal of Obstetrics and Gynaecology Canada. 2021 Oct 1;43(10):1188-204. DOI: https://doi.org/10.1016/j.jogc.2021.08.003

Faubion SS, Crandall CJ, Davis L, El Khoudary SR, Hodis HN, Lobo RA, Maki PM, Manson JE, Pinkerton JV, Santoro NF, Shifren JL. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022 Jul 1;29(7):767-94. DOI: https://doi.org/10.1097/GME.0000000000002028

Baber RJ, Panay N, Fenton AT. 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric. 2016 Mar 3;19(2):109-50. DOI: https://doi.org/10.3109/13697137.2015.1129166

Black D. The safety of oral versus transdermal estrogen. Menopause. 2020 Nov 1;27(11):1328-9. DOI: https://doi.org/10.1097/GME.0000000000001636

Kapoor E, Kling JM, Lobo AS, Faubion SS. Menopausal hormone therapy in women with medical conditions. Best Practice & Research Clinical Endocrinology & Metabolism. 2021 Dec 1;35(6):101578. DOI: https://doi.org/10.1016/j.beem.2021.101578

Berg WA, Seitzman RL, Pushkin JA. Implementing the National Dense Breast Reporting Standard, Expanding supplemental screening using current guidelines, and the proposed Find It Early Act. J Breast Imaging. 2023 Apr 15:wbad034. DOI: https://doi.org/10.1093/jbi/wbad034 DOI: https://doi.org/10.1093/jbi/wbad034

Greendale GA, Reboussin BA, Slone S, Wasilauskas C, Pike MC, Ursin G. Postmenopausal hormone therapy and change in mammographic density. Journal of the National Cancer Institute. 2003 Jan 1;95(1):30-7. DOI: https://doi.org/10.1093/jnci/95.1.30

Jacobson M, Mills K, Graves G, Wolfman W, Fortier M. Guideline No. 422f: Menopause and breast cancer. Journal of Obstetrics and Gynaecology Canada. 2021 Dec 1;43(12):1450-6. DOI: https://doi.org/10.1016/j.jogc.2021.09.011

Depypere H, Inki P. The levonorgestrel-releasing intrauterine system for endometrial protection during estrogen replacement therapy: a clinical review. Climacteric. 2015 Jul 4;18(4):470-82. DOI: https://doi.org/10.3109/13697137.2014.991302

Kenemans P, Speroff L, International Tibolone Consensus Group. Tibolone: clinical recommendations and practical guidelines: a report of the International Tibolone Consensus Group. Maturitas. 2005 May 16;51(1):21-8. DOI: https://doi.org/10.1016/j.maturitas.2005.02.011

Lundström E, Christow A, Kersemaekers W, Svane G, Azavedo E, Söderqvist G, Mol-Arts M, Barkfeldt J, von Schoultz B. Effects of tibolone and continuous combined hormone replacement therapy on mammographic breast density. American Journal of Obstetrics and Gynecology. 2002 Apr 1;186(4):717-22. DOI: https://doi.org/10.1067/mob.2002.121896

Hammar ML, Van De Weijer P, Franke HR, Pornel B, Von Mauw EM, Nijland EA, TOTAL Study Investigators Group. Tibolone and low‐dose continuous combined hormone treatment: vaginal bleeding pattern, efficacy and tolerability. BJOG. 2007 Dec;114(12):1522-9. DOI: https://doi.org/10.1111/j.1471-0528.2007.01537.x

Archer DF, Lewis V, Carr BR, Olivier S, Pickar JH. Bazedoxifene/conjugated estrogens (BZA/CE): incidence of uterine bleeding in postmenopausal women. Fertility and Sterility. 2009 Sep 1;92(3):1039-44. DOI: https://doi.org/10.1016/j.fertnstert.2009.05.093

Harvey JA, Pinkerton JV, Baracat EC, Shi H, Chines AA, Mirkin S. Breast density changes in a randomized controlled trial evaluating bazedoxifene/conjugated estrogens. Menopause. 2013 Feb 1;20(2):138‑45. DOI: https://doi.org/10.1097/GME.0b013e318271f5e7

Black, D. Diagnosis and medical management of premenopausal and postmenopausal bleeding. Climacteric 2023;26(3):222-228. DOI: https://doi.org/10.1080/13697137.2023.2178893

Kim SE, Lee DY, Choi D. Tissue-selective estrogen complex for women who experience breast discomfort or vaginal bleeding when on hormone therapy. Menopause. 2019 Apr 1;26(4):383-6. DOI: https://doi.org/10.1097/GME.0000000000001244

Boardman HM, Hartley I, Eisinga A, et al. Hormone therapy for preventing cardiovascular disease in post-menopausal women. Cochrane Database Syst Rev. 2015 Mar 10;2015(3):CD002229. DOI: https://doi.org/10.1002/14651858.CD002229.pub4

Collaborative Group on Hormonal Factors in Breast Cancer. Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence. Lancet. 2019 Sep 28;394(10204):1159-68. DOI: https://doi.org/10.1016/S0140-6736(19)31709-X

Published

2023-10-25

How to Cite

1.
Black D. Menopause Hormone Therapy: 2023 Update. Can Prim Care Today [Internet]. 2023 Oct. 25 [cited 2024 Apr. 19];1(3):17-21. Available from: https://canadianprimarycaretoday.com/article/view/1-3-black

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