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Current recommendations: what is the clinician to do?
Menopausal hormone therapy (HT) has complex biologic effects but continues to have an important clinical role in the management of vasomotor and other menopausal symptoms. The rational use of menopausal HT requires balancing the potential benefits and risks of treatment. Findings from the Women's Health Initiative (WHI) and other randomized clinical trials have helped to clarify the benefits and risks of HT and have provided insights to improve decision making. Several clinical characteristics have utility in identifying women for whom benefits of HT are likely to outweigh the risks. Age and time since menopause are strong...
Source: Fertility and Sterility - March 31, 2014 Category: Reproduction Medicine Authors: JoAnn E. Manson Tags: Views and reviews Source Type: research

Cardiovascular benefits of HRT may differ by patient age
Commentary on: Main C, Knight B, Moxham T, et al.. Hormone therapy for preventing cardiovascular disease in post-menopausal women. Cochrane Database Syst Rev 2013;(4):CD002229. Context In early postmenopausal women oestrogen and/or hormone replacement therapy (ERT/HRT) are used to alleviate symptoms and reduce the probability of diseases related to ovarian hormones deprivation. However, in late postmenopausal women the initiation of HRT has a negative risk/benefit balance mainly because of the increased risk of cardiovascular diseases (CVD). Methods Main et al performed a meta-analysis of randomised controlled trials (RCTs...
Source: Evidence-Based Medicine - March 19, 2014 Category: Internal Medicine Authors: Rosano, G., Vitale, C. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Contraception, Drugs: obstetrics and gynaecology, Menopause (including HRT), Interventional cardiology, Ischaemic heart disease, Venous thromboembolism, Radiology Source Type: research

Association of Ischemic Stroke, Hormone Therapy, and Right to Left Shunt in Postmenopausal Women
Conclusions Approximately 20% of older women have a right to left shunt. Hormone therapy in these women may increase the risk of ischemic stroke by promoting paradoxical embolism. © 2014 Wiley Periodicals, Inc.
Source: Catheterization and Cardiovascular Interventions - February 12, 2014 Category: Cardiovascular & Thoracic Surgery Authors: Nancy C. Greep, David S. Liebeskind, Rubine Gevorgyan, Tam Truong, Bennett Cua, Chi‐Hong Tseng, David W. Dodick, Bart M. Demaerschalk, David E. Thaler, Jonathan M. Tobis Tags: Original Studie Source Type: research

Hormone Therapy in Women After Heart Transplantation
Conclusions: HT is not associated with poor outcome or adverse effects in female heart transplant patients after age 35 years. However, a larger cohort of patients is necessary to confirm these observations.
Source: Transplantation Proceedings - November 1, 2013 Category: Transplant Surgery Authors: L.C. Kobashigawa, M. Hamilton, M. Rafiei, L. Stern, C.N. Bairey Merz Tags: Thoracic Transplantation Source Type: research

While hormone therapy unlikely harmful in younger postmenopausal women at low CV risk, protective effects cannot be claimed
Commentary on: Schierbeck LL, Rejnmark L, Tofteng CL, et al.. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. BMJ 2012;345:e6409. Context The last 10 years have clarified the issues regarding postmenopausal hormone therapy (HT) and cardiovascular disease (CVD). Prior to the large, randomised women's health initiative (WHI),1 observational studies had suggested a protective cardiovascular (CV) effect. The WHI showed no benefit, and increased thromboembolic and CV events in women taking HT. The WHI findings have been challenged because of the older age of the...
Source: Evidence-Based Medicine - September 19, 2013 Category: Internal Medicine Authors: Abramson, B. L. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Menopause (including HRT), Ischaemic heart disease, Venous thromboembolism Therapeutics Source Type: research

Hormone therapy not recommended for chronic disease prevention in menopausal women
Commentary on: Nelson HD, Walker M, Zakher B, et al.. Menopausal hormone therapy for the primary prevention of chronic conditions: a systematic review to update the US Preventive Services Task Force recommendations. Ann Intern Med 2012;157:104–13. Context In 2005, the US Preventive Services Task Force (USPSTF) updated its 2002 hormone replacement therapy recommendations, advising against the routine use of oestrogen and progestin (E+P) and unopposed oestrogen (E) to prevent chronic conditions in menopausal women. Menopausal hormone therapy (MHT) had been commonly prescribed to prevent conditions such as cardiovascula...
Source: Evidence-Based Medicine - May 15, 2013 Category: Internal Medicine Authors: Wenger, N. K. Tags: Pancreas and biliary tract, Epidemiologic studies, Drugs: cardiovascular system, Dementia, Stroke, Contraception, Drugs: obstetrics and gynaecology, Menopause (including HRT), Ischaemic heart disease, Venous thromboembolism, Memory disorders (psychiatry), Source Type: research

Lessons Learned From the Women's Health Initiative Trials of Menopausal Hormone Therapy.
Abstract We re-evaluate the Women's Health Initiative findings and their implications for clinical practice. Menopausal hormone therapy (HT) was effective for relief of vasomotor symptoms, and the risk of coronary heart disease (CHD) tended to be reduced in women close to menopause compared with the increased risk in women more distant from menopause. In recently menopausal women, short-term absolute risks of stroke and venous thromboembolism were small. Estrogen plus progestin therapy, but not estrogen therapy, increased the risk of breast cancer with a suggestion of greater risk when initiated close to the menop...
Source: Obstetrics and Gynecology - January 1, 2013 Category: OBGYN Authors: Rossouw JE, Manson JE, Kaunitz AM, Anderson GL Tags: Obstet Gynecol Source Type: research

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