Menopause: new developments that are changing patient care

A closer look at WHI data on hormone therapy and breast cancer risk is reassuring, and a new paradigm for osteoporosis treatment is on its way.

ObGyns and their patients are the beneficiaries of a steady stream of scientific data on issues relating to menopause. In last year’s Update, I focused on the question of whether menopausal hormone therapy (HT) increases the risk of breast cancer. Because breast cancer continues to top the list of women’s concerns, I will use this year’s Update to assess what we have recently learned about HT and breast cancer, and to explore the latest data on nonhormonal management of vasomotor symptoms.

I am delighted that Dr. Michael McClung, an internationally recognized expert in skeletal health, has agreed to review current evidence on the prevention of osteoporotic fractures in menopausal women in the latter part of this article.

New WHI analysis confirms safety of short-term combination HT

Anderson GL, Chlebowski RT, Rossouw JE, et al. Prior hormone therapy and breast cancer risk in the Women’s Health Initiative randomized trial of estrogen and progestin. Maturitas. 2006;55:103–115.

At the annual San Antonio Breast Cancer Symposium in December, investigators presented data showing that the incidence of breast cancer in US women decreased by 7% from 2002 to 2003, a striking decline that was most prominent among women aged 50 to 69 years. The presenters speculated that the plummeting rates of HT use following publication of the initial Women’s Health Initiative (WHI) findings in the summer of 2002 (in regard to the estrogen–progestin arm) might be responsible for this decline.

The major media attention that followed this presentation makes one thing clear: Concerns about developing breast cancer with HT use continue to fuel anxiety among women. Although secular trend data on the national breast cancer incidence can help generate hypotheses, they cannot explain the trends. What can shed light on the association between estrogen–progestin HT and breast cancer are important new data recently released by WHI investigators.

Andrew M. Kaunitz, MD
Professor and Assistant Chairman, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, Fla.
Dr. Kaunitz serves on the OBG Management Board of Editors.

Michael McClung, MD
Founding Director, Oregon Osteoporosis Center, and Associate Professor of Medicine, Oregon Health Sciences University, Portland, Ore

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