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When is it appropriate to prescribe postmenopausal hormone therapy?

Ettinger, Bruce MD1; Barrett-Connor, Elizabeth MD2; Hoq, Lalima A. MD, MPH3; Vader, John-Paul MD, MPH4; Dubois, Robert W. MD, PhD3

doi: 10.1097/01.gme.0000188735.61994.5b

Objective: To develop evidence and consensus-based recommendations for the use of hormone therapy (HT) in postmenopausal women.

Design: Using evidence from clinical trials and other publications, a multidisciplinary group of women's health experts developed consensus-based recommendations for HT use in more than 300 clinical scenarios. These panelists utilized the RAND Appropriateness Method and a quantitative scale to rate the appropriateness of treatment options for women with various risk factors and clinical scenarios.

Results: The panel judged it appropriate to prescribe all forms of HT to women with intolerable menopause symptoms and usual (age-expected) risks of cardiovascular disease (CVD), venous thromboembolism (VTE), or stroke. Use of HT was judged not appropriate for the clinical scenarios of bone preservation, cosmetic appearance, current memory loss, loss of libido, or CVD protection. For a woman still using HT after 5 or more years, it was considered appropriate to recommend the options of stopping or lowering the dose even if stopping was previously attempted. In treating intolerable symptoms in the presence of some elevated risk for diseases related to HT, route of administration may affect appropriateness but prior stroke or TIA# is a contraindication.

Conclusions: Standard HT is appropriate for women with intolerable menopause symptoms in the absence of HT-related risk factors (eg, CVD, stroke, VTE, breast cancer). Panelists judged it appropriate to repeatedly present the option of stopping or reducing the dose. In most cases, presence of risk factors makes standard-dose oral HT not appropriate; however, some women may be candidates for a different dose or route of administration.

After reviewing a number of case scenarios, an expert panel offers its consensus on when it is appropriate to prescribe postmenopausal hormone therapies.

From the 1University of California, San Francisco, San Francisco, CA; 2Department of Family and Preventive Medicine, University of California, San Diego, San Diego, CA; 3Cerner Health Insights, Beverly Hills, CA; and 4Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland.

Received June 30, 2005; revised and accepted September 13, 2005.

This study was funded by an unrestricted grant from Berlex Pharmaceuticals, Montville, NJ.

Address correspondence to: Bruce Ettinger, MD, 156 Lombard Street #3, San Francisco, CA 94111. E-mail:

©2006The North American Menopause Society