Premature menopause: management challenges after the Women's Health Initiative.

Abstract

Correspondence: Dr Julie Ayres, Hospital Practitioner, Menopause Clinic, Gynaecology Outpatient Department, Clarendon Wing, General Infirmary at Leeds, Belmont Grove, Leeds LS2 9NS, UK. Email: Julie.ayres@leedsth.nhs.uk If the media can twist official statements on the subject of hormone replacement therapy (HRT) and its safety (or otherwise), what chance does Josephine public have of really understanding the issues that she needs to cover before committing herself to taking something that she has been led to believe might kill her? Consultations, for menopausal women, take a great deal of time to equip patients with enough information to facilitate an informed decision. But one area that should really be quite straight forward is the woman who has undergone a premature menopause, for whom the advice from regulatory authorities such as the Committee on Safety of Medicines is to take HRT until the average of menopause (51 years), during which time there is no evidence of an increased risk of breast cancer or cardiovascular disease. But time and time again I am seeing referrals for women who have been told to stop HRT, by their primary care physician, because they have taken it for 5, 10 years, or whatever their doctor decides is time enough, despite them still being under 50. It is important to emphasize that both the Women’s Health Initiative and the Million Women study were undertaken in women aged 50 and over.1,2 Their findings cannot be extrapolated to younger women, who would normally be producing their own endogenous estrogen. Indeed, I would suggest that a case could be made to illustrate the apparent differences in risk by referring to HRT under the age of 50 as true hormone ‘replacement’ and that HRT in the over-50s be referred to as hormone ‘extension’ therapy, at least in counselling those with a premature menopause. It is always pleasing to see a confused and worried patient’s face light up with understanding and relief over this important subject when this point is made. It is essential to assess studies critically and not to generically extrapolate the results of a single study or trial to all menopausal women.