POESIT recommendations on management of body-identical hormones in menopausal symptoms.
Santiago PalaciosCláudio RebeloAna CasquilhoAna Rosa CostaAngelo CagnacciAntonio CanoCamil Castelo-BrancoCostantino Di CarloFátima RomãoFernanda GeraldesMarco GambaccianiMaria FaseroPluvio CoronadoMaria João CarvalhoRossella Elena NappiPublished in: Climacteric : the journal of the International Menopause Society (2024)
Many women seek treatment to improve menopausal vasomotor symptoms (VMS). The selection of women most likely to benefit from menopause hormone therapy (MHT) is crucial in clinical practice. There is general agreement that women younger than 60 years or who initiate MHT within the first 10 years of menopause, with no contraindications, have greater benefits considering symptomatic relief and additional advantages. This group may have the advantage of protection from osteoporosis and from other chronic diseases that affect postmenopausal women, namely cardiovascular disease (CVD). Cumulating evidence supports MHT for symptomatic women. However, inadequate use according to the needs of symptomatic women led to a burden of suffering worldwide. In recent years, the emergent use of non-regulated body-identical hormones (non-rBHT) can expose patients to potential harms. These hormone preparations are not regulated through the same tests of safety, efficacy or dosing consistency as regulated-BHT (r-BHT). The POESIT (Portugal + Spain + Italy) recommendations highlight the use of 17β-estradiol (E2) and micronized progesterone (P4) as the real r-BHT. In addition, the group emphasizes as an example the data from the REPLENISH study with 1 mg E2/100 mg P4. The combination of the two hormones in one convenient pill showed a clear reduction or elimination of hot flashes and an improvement in sleep quality and, consequently, quality of life. At the same time, this combination has shown high rates of amenorrhea and no significant impact on lipid, glucose or coagulation parameters. Both the REPLENISH study and a real-life retrospective study pointed to the possibility of a lower risk of venous thromboembolism (VTE) with this formulation than with other combinations.
Keyphrases
- postmenopausal women
- polycystic ovary syndrome
- venous thromboembolism
- sleep quality
- clinical practice
- cardiovascular disease
- bone mineral density
- pregnancy outcomes
- cervical cancer screening
- breast cancer risk
- transcription factor
- end stage renal disease
- stem cells
- drug delivery
- type diabetes
- risk assessment
- peritoneal dialysis
- insulin resistance
- blood pressure
- physical activity
- electronic health record
- bone marrow
- big data
- cardiovascular risk factors
- body composition
- cell therapy
- cardiovascular events
- climate change