Newsflash: International Menopause Society has issued updated guidelines on HRT

Posted by on Jun 10, 2011 in HRT | 7 comments

Got news?

I sure do!

The International Menopause Society has issued updated recommendations on the use of hormone replacement therapy (HRT, a term that they use to refer to estrogen, progesterone, combined therapies, androgens and tibolone). They note that the current guidelines are similar to those issued in 2007 but “include additional clinical data where needed.” And while they claim that there are “no reasons to place mandatory limitations on how long HRT is used (which by the way, runs counter to current recommendations of several major national and international medical associations), they do emphasize that HRT “should not be recommended without a clear indication for use, i.e. significant symptoms or physical effects of estrogen deficiency.”

The following are some highlights of the updated report:

  • HRT should be used at the lowest effective dose to effectively reduce symptoms and maintain life quality
  • Women who enter early menopause either spontaneously or due to hysterectomy or other condition before age 45 and particularly before age 40 may be at increased risk for heart disease, osteoporosis, mental disorders or dementia. Notably, the evidence of reduction of this risk via HRT is limited but is nevertheless recommended to preserve bone and reduce symptoms, at least until they enter the average age for menopause (i.e. ~52)
  • Progestogen should be added to estrogen in all women with an intact uterus to prevent endometrial malignancies and cancer (except for in the case of low-dose estrogen)
  • HRT is recommended to preserve bone health although it should not be started after age 60 and loses its effectiveness once therapy is stopped.
  • Despite the controversy as to whether or not HRT is heart protective, the IMS says that it has the potential to boost or improve one’s risk profile because of how it affects the vascular system, metabolism of blood sugar, blood pressure and cholesterol levels. However, this recommendation is also framed within the recommendation that women adopt major primary prevention measures, such as stopping smoking, regular exercise, weight control, blood pressure reduction, and control of diabetes and blood pressure.

So, what about the risks of HRT that I’ve long written about on this blog? The convened panel disputes the conclusion of the Women’s Health Initiative (due to average older age of participants and when they started HRT) as well as data that have come down the pike since 2002. In fact, they say that the link with breast cancer is controversial and that HRT doesn’t initiate cancer (but rather, promotes an existing tumour). They also concur that data are still lacking with regards to type of HRT, doses, and administration type and incidence of breast cancer. And, with regards to endometrial cancer or stroke? They write that women with a uterus should be certain to add a progesterone component to their hormones to counteract any undue stimulation of their endometrium, and that stroke risk is related to increasing age and obesity, noting that risks may be avoided by using an estrogen patch or stopping use of hormones after the age of 60.

In general, the conclusion of the panel is than “most menopausal women have little to fear from the adverse effects of HRT” and that the benefits of hormone therapy outweigh the risks. Still, they do suggest that the decision to take HRT should be discussed with a physician and reviewed annually.

Not surprisingly, alternative therapies are completely
discounted in the IMS guidelines and they do not support the use of any bioidentical hormones whatsoever. Moreover, they make a point to place blame on the media without providing clear examples of their claims for “superficial and uncritical evaluations” of HRT, as if all media were one and the same.

I am not quite sure what to make of these recommendations. On one hand, they claim to have reviewed all the data since WHI but this panel convened four years ago. And while they are sure to promote HRT within a cautious framework, menopause continues to be positioned as a disease requiring treatment.Indeed, one of the report authors, Dr. Roger Lobos (Columbia University, New York), says that “the bottom line is that most doctors nowadays should feel comfortable about prescribing HRT to most women going through the menopause [but] like most medicines, you need to look at individual circumstances before deciding to taken it.”

Notably, media are once again positioned as the big bad wolf that misconstrue findings and attack  pharmaceutical companies for their profit motivations.

Has anything really changed except the date of the report? Well, the good news is that the IMS acknowledges that there are risks associated with HRT, at least for some women. And yet, the report still appears lack objectivity.

Do yourself a favour. Speak to your practitioner. HRT will shut down your symptoms. Period. But you must ask yourself, at what cost? Do your research. Ask the hard questions. And then ask them again.

You may be sweating. But the issue is greater than the sum of all sweats.


  1. 6-11-2011

    Fabulous post, Liz. and desperately needed. As we know, there is a lot of money to be made here. If they keep it vague–and then push it out to docs and patients, it has the effect of more women thinking that they fit, and can’t question. Boy do I hope this is not poised for a comeback.

    Laura Newman,

    • 6-11-2011

      Thanks Laura. I was a bit surprised by the findings and lack of interest in alternatives or in more clearly defining the issues. But then again, it’s an association that has pockets somewhere (even those aren’t very clear). I just hope that women will continue to be vigilant!

  2. 6-15-2011

    Thank you! Great post and very true. Women need to be informed about their choices. ALL of their choices. I am on bioidentical hormones that were prescribed to be based on my comprehensive lab results. Then the hormones are compounded specifically for me. HRT is not a one size fits all treatment and people need to get educated before making these decisions. I agree that women need to talk to their practitioners. Then if they want more options, get a second opinion. It is your health! You have every right to feel amazing!

    • 6-15-2011

      Thanks for commenting and sharing your personal experience. Women need to know that there ARE other choices and one size does not fit all. Cheers.

  3. 7-9-2011

    In 1941 – 70 year ago HRT was approved by FDA in USA. Since then HRT was the only treatment for menopause available. Needles to say that pharmaceutical industry and medical profession have immensely profited from women going through the menopause. After it was discovered that the treatment is more harmful than beneficial both the pharmaceutical industry and the medical profession found themselves in ‘limbo’ – they do not have an alternative as no one invested a single cent in finding out any better ‘treatment’. The money hungry professions just dance around the issue trying desperately to sell i.e. promote the use of HRT via back door as there is no alternative. I am appalled and disturbed. The menopause is a nasty process where your body shuts down the certain way. Giving birth is a natural process – but you do not see the women giving birth just anywhere. Menopause is a natural process but women are left with very few options.

  4. 7-27-2011

    I agree with above:I am on bioidentical hormones that were prescribed to be based on my comprehensive lab results. Then the hormones are compounded specifically for me. HRT is not a one size fits all treatment and people need to get educated before making these decisions. I agree that women need to talk to their practitioners. Then if they want more options, get a second opinion. It is your health! You have every right to feel amazing!When I went to I wasn’t sure about it but when they explained Biodentical Hormone Replacement Therapy and all the different options it made sense and I haven’t felt the same sense.

    • 7-28-2011

      Thanks Kris. All important points. Informed decision making is imperative. Thank you for reading/commenting!


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