Hormone Therapy for Menopausal Symptoms
Authors: Eileen E. Reynolds, Carol Bates, Martha Richardson, Risa B. Burns
Journal: Annals of Internal Medicine (2018)

Letters7 August 2018Hormone Therapy for Menopausal SymptomsEileen E. Reynolds, MD, Carol Bates, MD, Martha Richardson, MD, and Risa B. Burns, MD, MPHEileen E. Reynolds, MDBeth Israel Deaconess Medical Center, Boston, Massachusetts (E.E.R., C.B., M.R., R.B.B.)Search for more papers by this author, Carol Bates, MDBeth Israel Deaconess Medical Center, Boston, Massachusetts (E.E.R., C.B., M.R., R.B.B.)Search for more papers by this author, Martha Richardson, MDBeth Israel Deaconess Medical Center, Boston, Massachusetts (E.E.R., C.B., M.R., R.B.B.)Search for more papers by this author, and Risa B. Burns, MD, MPHBeth Israel Deaconess Medical Center, Boston, Massachusetts (E.E.R., C.B., M.R., R.B.B.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L18-0239 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Dr. Robbins suggests that using estrogen without a progestogen but with regular endometrial surveillance is a reasonable approach to hormone therapy, especially given the results of the WHI trial showing that breast cancer risk was slightly reduced in the unopposed estrogen group compared with the placebo group (for breast cancer mortality, the hazard ratios were 1.44 [95% CI, 0.97 to 2.15; P = 0.07] for conjugated equine estrogen plus MPA and 0.55 [CI, 0.33 to 0.92; P = 0.02] for conjugated equine estrogen alone) (1). Although this difference may suggest an adverse effect of progestogens on breast tissue, the reason ...References1. Manson JE, Aragaki AK, Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, et al; WHI Investigators. Menopausal hormone therapy and long-term all-cause and cause-specific mortality: the Women's Health Initiative randomized trials. JAMA. 2017;318:927-38. [PMID: 28898378] doi:10.1001/jama.2017.11217 CrossrefMedlineGoogle Scholar2. The NAMS 2017 Hormone Therapy Position Statement Advisory Panel. The 2017 hormone therapy position statement of the North American Menopause Society. Menopause. 2017;24:728-53. [PMID: 28650869] doi:10.1097/GME.0000000000000921 CrossrefMedlineGoogle Scholar3. Asi N, Mohammed K, Haydour Q, Gionfriddo MR, Vargas OL, Prokop LJ, et al. Progesterone vs. synthetic progestins and the risk of breast cancer: a systematic review and meta-analysis. Syst Rev. 2016;5:121. [PMID: 27456847] doi:10.1186/s13643-016-0294-5 CrossrefMedlineGoogle Scholar4. Mørch LS, Skovlund CW, Hannaford PC, Iversen L, Fielding S, Lidegaard Ø. Contemporary hormonal contraception and the risk of breast cancer. N Engl J Med. 2017;377:2228-39. [PMID: 29211679] doi:10.1056/NEJMoa1700732 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Beth Israel Deaconess Medical Center, Boston, Massachusetts (E.E.R., C.B., M.R., R.B.B.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-3320. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoShould This Patient Receive Hormone Therapy for Her Menopausal Symptoms? Eileen E. Reynolds , Carol Bates , Martha Richardson , and Risa B. Burns Hormone Therapy for Menopausal Symptoms John Robbins Metrics 7 August 2018Volume 169, Issue 3Page: 203KeywordsBreast cancerDisclosureEstrogensHormonal therapyHormonesIntrauterine devicesMortalityProgesteroneProgestogensUltrasound imaging ePublished: 7 August 2018 Issue Published: 7 August 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...