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There is no evidence of an adverse effect with regard to recurrence of vulval disease.Individuals requiring HRT should be risk assessed and counselled regarding their venous thromboembolism (VTE) risk.Routine thrombophilia testing is not required prior to commencing HRT but testing might be considered if there is a personal or family history of thrombosis.Evidence from RCTs including the WHI as well as large observational studies has shown that oral estrogens increase the risk of VTE two- to four-fold, with the highest risk being in the first year of use.VTE risk is further increased in those with a personal or family history of VTE, advanced age particularly beyond the age of 60, obesity and other risk factors such as surgery or hospitalisation.Evidence from large observational studies and meta-analyses has shown that transdermal administration of estradiol is unlikely to increase the risk of VTE above that in non-users and is associated with a lower risk compared with oral administration of estradiol.In addition, the risk of VTE may be affected by the type of progesterone used within HRT. 0000065615 00000 n The British Menopause Society (BMS) & Women’s Health Concern 2016 recommendations on hormone replacement therapy (HRT) provide updated guidance based on recently published literature since the previous edition. The review included six RCTs with 1571 participants.
A total of 643 postmenopausal women were randomised to receive either oral estrogen (1 mg estradiol) plus micronised progesterone vaginal gel for women with a uterus or placebo. In addition, there is evidence that cognitive behavioural therapy may be beneficial for the management of low mood and anxiety.Women with severe depression should be referred for mental health assessment.Traditionally referred to as vulvovaginal atrophy, the North American Menopause Society and International Society for the Study of Women’s Sexual Health have proposed the new terminology ‘Genitourinary syndrome of the menopause’ to indicate that both the urinary and genital areas can be affected by this condition (Portman et al., 2014). The risks of hormone replacement including the risk of breast cancer quoted in the WHI and other studies on naturally menopausal women over the age of 50, do not apply to women with POI.Hormone therapy should generally continue at least until the estimated age of natural menopause (on average 51 years).HRT is also important to preserve uterine function in women planning ovum donation.Women with POI can have intermittent ovarian activity and have a chance of natural conception.
"This will optimise quality of life and facilitate the primary prevention of long-term conditions which create a personal, social and economic burden. Women with risk factors for stroke should therefore be advised to take transdermal estradiol in preference to oral estradiol.The type of progesterone used in HRT may have an effect on the risk of stroke. 0000003733 00000 n In addition, vaginal micronised progesterone may provide endometrial protection if applied sequentially for 10 days/month in a dose of 45 mg/day at 4% or every other day in a dose of 100 mg/day for up to 3–5 years. The trial was ended prematurely in 2007, as interim analysis showed an overall increased risk of breast cancer recurrence in the tibolone group. "When first introduced more than a decade ago, HRT was considered to be the "elixir of youth," but accumulating evidence has highlighted associated risks precluding widespread use. Evidence from observational studies suggests that micronised progesterone and pregnane derivatives such as dydrogesterone may be associated with a lower risk of VTE compared to other progestogens.Menopausal women who are at increased risk of VTE including those with raised body mass index should be advised to take transdermal estradiol in preference to oral estradiol as the former is unlikely to increase their risk of venous thrombosis.
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