Hormone Replacement Therapy in Menopause — a Discussion of Risks and Benefits, with Guidelines, from the British Menopause Society — an Example of Helpful Medicine from a Group Unafraid to Tangle with Medical Ambiguity

© 2013 Peter Free

 

28 May 2013

 

 

Citation

 

Nick Panay, Haitham Hamoda, Roopen Arya, and Michael Savvas, The 2013 British Menopause Society & Women’s Health Concern recommendations on hormone replacement therapy, Menopause International, doi: 10.1177/1754045313489645 (published online before print, 23 May 2013)

 

 

Background

 

Hormone replacement therapy for menopausal symptoms evolved from an initial given to a worrisomely ambiguous question over the past two decades.

 

The British Menopause Society has now looked at the issues and come up with some guidelines.  I mention these because I looked at the literature myself just a few months ago and came to the same conclusions.

 

 

Overview of the Society’s recommendations

 

From the paper:

 

 

The HRT [hormone replacement therapy] dosage, regimen and duration should be individualised, with annual evaluation of pros and cons.

 

Arbitrary limits should not be placed on the duration of usage of HRT; if symptoms persist, the benefits of hormone therapy usually outweigh the risks.

 

HRT prescribed before the age of 60 has a favourable benefit/risk profile.

 

It is imperative that women with POI [premature ovarian insufficiency] are encouraged to use HRT at least until the average age of the menopause.

 

If HRT is to be used in women over 60 years of age, lower doses should be started, preferably with a transdermal route of administration.

 

It is imperative that in our ageing population research and development of increasingly sophisticated hormonal preparations should continue to maximise benefits and minimise side effects and risks.

 

This will optimise quality of life and facilitate the primary prevention of long-term conditions which create a personal, social and economic burden.

 

© 2013 Nick Panay, Haitham Hamoda, Roopen Arya, and Michael Savvas, The 2013 British Menopause Society & Women’s Health Concern recommendations on hormone replacement therapy, Menopause International, doi: 10.1177/1754045313489645 (published online before print, 23 May 2013)

 

The paper includes a system by system bodily review of replacement therapy’s effects and dangers.

 

 

The moral? — The Brits know how to do this evidence-presenting “stuff”

 

I recently criticized the US Preventive Services Task Force’s mammogram guidelines for failing to “sell” its 2009 mammography screening guidelines with appropriate supporting information and transparent reasoning.

 

In comparison, the British Menopause Society’s hormone replacement guidelines are more clearly stated and supported.

 

I do not mean to imply that hormone replacement therapy is as evidentiarily ambiguous or (perhaps) potentially dangerous (per specific individual) as lapses in breast cancer screening.

 

But I do think that there is often something about being British that promotes the combination of language and evidence in more rationally convincing ways than we often logically sloppy Americans are able to.

 

That is not simply a throwaway jab at my own culture.  It is an appeal to using Logic’s full facility more frequently and concisely than we customarily do.  And that is a poke at American education, which seems more often than not to reject direct emphasis on enhancing critical thinking ability and rationally reasoned argument.