The endometrial and breast safety of menopausal hormone therapy containing micronised progesterone: A short review

Eden, John

doi:10.1111/ajo.12583

Cited by 8 publications

(8 citation statements)

References 23 publications

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“…A meta-analysis suggested increased risk of endometrial cancer (relative risk [RR], 1.2) with noncontinuous combined EPT (type of progestogen not specified) but not with continuous EPT 10 . Oral MP should be adequately dosed for prevention of endometrial hyperplasia (eg, 200 mg/d for 12-14 d/mo) 11,12 . Off-label use of a levonorgestrel-containing intrauterine device to prevent endometrial hyperplasia may avoid adverse systemic effects of progestogens and can protect against unwanted pregnancy in women initiating hormone therapy for symptom management before their final menstrual period.…”

Section: Formulation Dosing Routes Of Administration and Safetymentioning

confidence: 99%

The 2022 hormone therapy position statement of The North American Menopause Society

2022

Menopause

332

219

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and identifies future research needs. An Advisory Panel of clinicians and researchers expert in the field of women's health and menopause was recruited by NAMS to review the 2017 Position Statement, evaluate new literature, assess the evidence, and reach consensus on recommendations, using the level of evidence to identify the strength of recommendations and the quality of the evidence. The Advisory Panel's recommendations were reviewed and approved by the NAMS Board of Trustees.Hormone therapy remains the most effective treatment for vasomotor symptoms (VMS) and the genitourinary syndrome of menopause and has been shown to prevent bone loss and fracture. The risks of hormone therapy differ depending on type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is used. Treatment should be individualized using the best available evidence to maximize benefits and minimize risks, with periodic reevaluation of the benefits and risks of continuing therapy.For women aged younger than 60 years or who are within 10 years of menopause onset and have no contraindications, the benefit-risk ratio is favorable for treatment of bothersome VMS and prevention of bone loss. For women who initiate hormone therapy more than 10 years from menopause onset or who are aged older than 60 years, the benefit-risk ratio appears less favorable because of the greater absolute risks of coronary heart disease, stroke, venous thromboembolism, and dementia. Longer durations of therapy should be for documented indications such as persistent VMS, with shared decision-making and periodic reevaluation. For bothersome genitourinary syndrome of menopause symptoms not relieved with over-the-counter therapies in women without indications for use of systemic hormone therapy, low-dose vaginal estrogen therapy or other therapies (eg, vaginal dehydroepiandrosterone or oral ospemifene) are recommended.

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Section: Formulation Dosing Routes Of Administration and Safetymentioning

confidence: 99%

The 2022 hormone therapy position statement of The North American Menopause Society

2022

Menopause

332

219

View full text Add to dashboard Cite

show abstract

“…HT for longer than 5 years was significantly related to an increased incidence of breast cancer in patients ages 50-69 (91). Recent data also indicated that HT containing micronized progesterone appears to be safe for the breasts with a markedly lower risk of breast cancer in comparison to HT with progestins (92). Although current thinking suggests that estrogenprogestogen combinations have a potential risk of promoting breast cancer, some scholars have contended that the practical risk is not as high as that for other endogenous factors or lifestyle factors (93).…”

Section: Breast Cancer and Endometrial Cancermentioning

confidence: 99%

Update on hormone therapy for the management of postmenopausal women

Pan

Zhou

et al. 2022

BST

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Hormone therapy (HT) has been used in postmenopausal women for decades in clinical practice. With further analysis and newer studies, the benefits and risks of HT have been repeatedly verified and discussed. HT is recommended for the treatment of vasomotor symptoms (VMS), genitourinary syndrome of menopause (GSM) and the prevention of osteoporosis. However, the precise association between HT and the risks of cardiovascular diseases, venous thromboembolism, neurodegenerative diseases, breast cancer, and endometrial cancer remains controversial. Therefore, determining how to take advantage of and control the risks of HT by adjusting the initiation time, regimen, and duration is crucial. Recent studies have indicated that HT is not related to the risk of all-cause, cardiovascular, or breast cancer mortality although it might increase the incidence of some chronic diseases. For symptomatic postmenopausal women under the age of 60 without contraindications, early initiation of HT is safe and probably has a mortality benefit over the long term. Initiating HT close to menopause at the lowest effective dose is more likely to have maximal benefits and the lowest risks. Transdermal and vaginal HT may have a lower risk, but recent evidence suggests additional clinical benefits of oral HT formulations in relieving VMS and preventing osteoporosis. The pooled cohort risk equation for atherosclerotic cardiovascular disease (ASCVD) and the free app named Menopro can be used to perform individual risk assessments. In addition, Chinese herbal medicines have benefits in alleviating hot flashes, depression, and menopausal symptoms, although further data are needed to strongly support their efficacy. Acupuncture and electroacupuncture have definite efficacy in the treatment of postmenopausal symptoms with few adverse effects, so they are a reasonable option as an alternative therapy for high-risk women. This review discusses the history of, guidelines on, and strategies for HT in order to make suggestions based on the most up-to-date evidence for the management of postmenopausal women.

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“…La PG administrada por vía oral, incluso en forma micronizada, muestra una amplia variación de absorción, biodisponibilidad interindividual y una vida media corta menor a 16 minutos; solo el régimen combinado cíclico de PG micronizada (PM) (200 mg durante 12 días cada mes) o continuo combinado (100 mg día) ha probado alta eficacia en conferir protección endometrial sin efectos secundarios sobre la presión arterial, perfil de lípidos y riesgos trombóticos [31][32][33] .…”

Section: Progesteronaunclassified

“…Al igual que el estudio PEPI, el estudio KEEPS (Kronos Early Estrogen Prevention Study) no probó diferencia estadísticamente significativa en la incidencia de cáncer de endometrio entre usuarias de placebo o TH 35 . A la fecha existen pocos datos sobre otras dosis y horarios de administración oral de PM 33 . Por lo tanto, es completamente inútil y deletéreo, calcular individualmente una dosis sustentado en únicamente en las concentraciones de PG salival o sérica.…”

Section: Progesteronaunclassified

Hormonas bioidénticas y fitoestrógenos

López-Juárez¹,

López-Tarabay²,

Pérez-Galván³

et al. 2021

RME

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In the last 20 years, the prescription of bioidentical hormones has increased exponentially, specifically in the treatment to alleviate symptoms of menopause. The increase in the use of these compounds responds to incomplete, incorrect or unsustainable information regarding the safety or efficacy that they claim as "natural" and "innocuous", alluding to their manufacture and "personalized" adjustment, however, none of the manufacturing or the control processes are standardized so the quality of these products are questionable. On the other hand, phytoestrogens are mostly classified as supplements, which are not subject to specific regulation, and the response to their use varies, depending on the existence of the appropriate intestinal microbiota for metabolize them into active compound. This document will review evidence related to the use of these formulations.

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The endometrial and breast safety of menopausal hormone therapy containing micronised progesterone: A short review

Cited by 8 publications

References 23 publications

The 2022 hormone therapy position statement of The North American Menopause Society

The 2022 hormone therapy position statement of The North American Menopause Society

Update on hormone therapy for the management of postmenopausal women

Hormonas bioidénticas y fitoestrógenos

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