Estrogens after menopause- can we continue to give them after 10 years?

Concluding our coverage of the Climacteric and Menopause session we’re looking at continuing MHT after 10 years. Martin presented a case study of an older patient. Back in 2002, he had a 78 year old patient who was suffering from severe vasomotor symptoms (VMS). However when she visited her GP in October 2003, she was told to stop MHT immediately as it was “criminal at this age”. She returned back to Martin in January 2004, suffering from severe VMS, saying she had to stop work and felt considerably older, as a result she re-started transdermal estrogen.

Unfortunately this is a scenario that happens repeatedly. A quarter of all women over the age of 65 still suffer from hot flushes and VMS may last far into their 80s-90s. In a study done in a group of women aged 85, about 16% of them experienced hot flushes during the day and/or night, and almost 10% were very to moderately distressed by their hot flushes. Among this group, almost 7% are still using MHT.

IMS, EMAS, NAMS and other menopause societies have all agreed that the majority of the time the benefits outweigh the risk for symptomatic women who initiate MHT when aged under 60 or within 10 years of menopause onset. Data from the WHI trial and other studies support the safe use of MHT for at least 5 years in healthy women if initiated before age 60, however there is no reason to place mandatory limitations on the duration of MHT.

In fact, it can be dangerous to withhold MHT from healthy women need continuation after 10 years. Impacts could include:

- Relapse of severe vasomotor symptoms (higher cardiovascular, depression and osteoporosis risk)

- Relapse/appearance of urogenital problems

- Higher risk for cognitive decline

- Compromised sex life

- Reduced Quality of Life

Therefore based on available evidence, it can be concluded that in healthy elderly women continuation of MHT beyond 10 years is safe. In order to minimise risk the lowest effective dose should be administered through a non-oral route with micronized progesterone or dydrogesterone if needed.