The British Menopause Society &amp; Women’s Health Concern 2020 recommendations on hormone replacement therapy in menopausal women

Hamoda, Haitham; Panay, Nick; Pedder, Hugo; Arya, Roopen; Savvas, M.

doi:10.1177/2053369120957514

Cited by 100 publications

(147 citation statements)

References 171 publications

(20 reference statements)

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“…Current guidelines recommend that MHT should be tailored to each woman, using the lowest effective dose of estrogen and progestogen to achieve an optimal balance between efficacy and safety with respect to breast cancer and cardiovascular effects, while addressing patient-specific needs and other risk factors [13,14].…”

Section: Discussionmentioning

confidence: 99%

“…Menopausal hormone therapy (MHT) is highly effective in reducing the vasomotor symptoms of menopause; a metaanalysis of 47 studies that included more than 8300 menopausal women reported that, of 16 treatments, MHT was the most effective for vasomotor symptoms [12]. The International Menopause Society and British Menopause Society guidelines on hormone therapy in menopause both recommend that MHT is the most effective treatment for reducing the vasomotor symptoms of menopause and should be tailored to each woman, using the lowest effective dose [13,14]. This is also reflected in the Chinese guideline on menopause management and hormone therapy, which recommends MHT for the treatment of vasomotor symptoms within 10 years following menopause [15].…”

Section: Introductionmentioning

confidence: 99%

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Ultra-low-dose estradiol and dydrogesterone: a phase III study for vasomotor symptoms in China

Ren

Ruan

et al. 2021

Climacteric

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Objective: This study aimed to evaluate the efficacy and safety of ultra-low-dose estradiol plus dydrogesterone for vasomotor symptoms in postmenopausal women in China (trial registration CTR20160689). Methods: A total of 332 patients were randomized to continuous combined estradiol 0.5 mg þ dydrogesterone 2.5 mg or placebo for 12 weeks. The primary efficacy endpoint was change in the number of hot flushes per day from baseline to end of treatment. Secondary efficacy endpoints included change in the number of moderate-to-severe hot flushes per day, menopausal symptoms from baseline and quality of life. Results: Between baseline and end of treatment, change in the mean number of hot flushes per day was À5.9 (95% confidence interval [CI] À 6.6, À5.2) with estradiol þ dydrogesterone and À4.5 (95% CI À5.1, À3.8) with placebo, with a mean difference of À1.4 hot flushes per day (95% CI À2.2, À0.7; p < 0.001). Significant differences in favor of estradiol þ dydrogesterone were also observed in several secondary efficacy endpoints. The study treatment was well tolerated. Conclusion: Continuous combined estradiol 0.5 mg þ dydrogesterone 2.5 mg reduced hot flushes in postmenopausal women in China. This ultra-low-dose regimen provides an additional option for women experiencing the vasomotor symptoms of menopause. These data are consistent with previous results in other populations.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ultra-low-dose estradiol and dydrogesterone: a phase III study for vasomotor symptoms in China

Ren

Ruan

et al. 2021

Climacteric

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“…Persistent unscheduled bleeding on HRT beyond six months warrants investigation with ultrasound scan and endometrial biopsy if clinically indicated. 11 Counselling patients who take seq- or con-HRT about unscheduled bleeding in the initial six months is crucial. Women need to be informed to report unscheduled vaginal bleeding at the three-month review appointment or promptly if it occurs after the first three months.…”

Section: Discussionmentioning

confidence: 99%

A cross-sectional national questionnaire survey assessing the views of members of the British Menopause Society on the management of patients with unscheduled bleeding on hormone replacement therapy

Idle

Panay

Hamoda³

2021

Post Reprod Health

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Objective To explore the views of members of the British Menopause Society on the management of women with unscheduled bleeding on hormone replacement therapy. Study design An electronic cross-sectional questionnaire survey. Main outcome measures Investigations, treatment options and preferences for the management of women with unscheduled bleeding on hormone replacement therapy. Results A total of 91/178 (51%) clinicians investigate patients with unscheduled bleeding within three to six months of starting sequential hormone replacement therapy (seq-HRT) versus 83/178 (47%) for continuous combined hormone replacement therapy (con-HRT). A total of 52/178 (29%) versus 54/178 (30%) would investigate unscheduled bleeding continuing beyond six months while 18/178 (10%) versus 26/178 (15%) would investigate within three months. Assessment is requested as urgent by 88/176 (50%) clinicians, routine by 47/176 (27%) and a two-week-wait-suspected cancer referral by 41/176 (23%). A total of 97/178 (55%) clinicians would continue seq-HRT and refer versus 117/178 (66%) for con-HRT. A total of 46/178 (26%) clinicians would change the progestogen preparation in women with unscheduled bleeding on seq-HRT. For women on con-HRT, 12/178 (7%) clinicians would change to seq-HRT and 8/178 (5%) to the Mirena IUS. The Mirena IUS is the preferred progestogen for 81/178 (45%) of clinicians when prescribing hormone replacement therapy. Conclusions There is a varied approach in the practise amongst British Menopause Society members to managing women with unscheduled bleeding on hormone replacement therapy. Further research is needed to determine the optimal assessment pathways for women with unscheduled bleeding on hormone replacement therapy.

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“…Hormonal replacement therapy (HRT). HRT is usually prescribed to reduce the vasomotor symptoms associated with the menopausal transition [ 100 , 101 ]. However, population-based studies suggest that HRT worsens migraine [ 32 , 102 , 103 ].…”

Section: Considerations On the Treatment Of Perimenopausal Migrainementioning

confidence: 99%

Acute and Preventive Management of Migraine during Menstruation and Menopause

Ornello

Felice

Caponnetto

et al. 2021

JCM

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Migraine course is influenced by female reproductive milestones, including menstruation and perimenopause; menstrual migraine (MM) represents a distinct clinical entity. Increased susceptibility to migraine during menstruation and in perimenopause is probably due to fluctuations in estrogen levels. The present review provides suggestions for the treatment of MM and perimenopausal migraine. MM is characterized by long, severe, and poorly treatable headaches, for which the use of long-acting triptans and/or combined treatment with triptans and common analgesics is advisable. Short-term prophylaxis with triptans and/or estrogen treatment is another viable option in women with regular menstrual cycles or treated with combined hormonal contraceptives; conventional prevention may also be considered depending on the attack-related disability and the presence of attacks unrelated to menstruation. In women with perimenopausal migraine, hormonal treatments should aim at avoiding estrogen fluctuations. Future research on migraine treatments will benefit from the ascertainment of the interplay between female sex hormones and the mechanisms of migraine pathogenesis, including the calcitonin gene-related peptide pathway.

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The British Menopause Society & Women’s Health Concern 2020 recommendations on hormone replacement therapy in menopausal women

Abstract: • All women should be able to access advice on how they can optimise their menopause transition and the years beyond.

Cited by 100 publications

References 171 publications

Ultra-low-dose estradiol and dydrogesterone: a phase III study for vasomotor symptoms in China

Ultra-low-dose estradiol and dydrogesterone: a phase III study for vasomotor symptoms in China

A cross-sectional national questionnaire survey assessing the views of members of the British Menopause Society on the management of patients with unscheduled bleeding on hormone replacement therapy

Acute and Preventive Management of Migraine during Menstruation and Menopause

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