IMS Updated Recommendations on postmenopausal hormone therapy.

摘要

The past decade has seen marked fluctuations in opinions concerning the merits and risks of postmenopausal hormone therapy. In July 2002, menopause management faced a major turning point when the first data from the Women's Health Initiative (WHI) trial were released. The study was categorized as a primary prevention trial for coronary heart disease, although the fact that mean age at recruitment was 63 years was not given enough importance at that time. WHI investigators concluded that hormone therapy (HT) was not cardioprotective, and, in fact, its risk-benefit ratio did not favor the use of postmenopausal hormones for prevention of chronic diseases. As a result, there was a dramatic change in prescription habits following recommendations to reserve HT for very symptomatic women, and to limit its use to the 'shortest duration needed, and 'to the lowest, effective dosage'. This was the atmosphere in which the International Menopause Society (IMS) initiated the IMS Workshop held in Vienna (December 2003) and the IMS Position Paper that was based on the Workshop discussions. Looking at global perspectives, and being independent of local or regional constraints imposed by official health authorities, this IMS Statement called for a more balanced approach in the interpretation of the scientific data on hormone use that were available in 2003. Since then, additional information has been accumulated from both arms of the WHI study, observational trials and from other studies, allowing a more comprehensive review on all issues related to the use of hormones in the postmenopausal period. In view of the above, the IMS Board decided that it is time to update the 2004 Statement and to enlarge its scope to menopause management and adult women's health in general. More than 30 experts from the various fields of menopause medicine reviewed the latest information in a Workshop held in Budapest in February 2007.