New HRT Guidelines from the British Menopause Society

The British medical Society has released updated guidelines on hormone replacement therapy. The new guidelines are published in Menopause International (SAGE XX June 2013.).
The new HRT (hormone replacement therapy) recommendations are designed to provide helpful and practical guidelines for health professionals who prescribe HRT and for women who are considering or currently using HRT.
Do you suffer from Hot Flashes?
One of the main reasons for prescribing HRT in postmenopausal women is to treat severe vasomotor symptoms otherwise known as hot flashes.
Has your mood changed?
HRT may also help improve depressive symptoms in the early menopause. Women with severe depression who do not respond to HRT will require psychiatric assessment.
Decreased libido?
Sexual function may be improved as a result of systemic or topical application of HRT to treat vaginal atrophy and dyspareunia. Systemic testosterone is known to improve sexual function.
Running to the bathroom more often?
Bladder and urethral epithelium proliferation as a result of HRT treatment may help relieve urinary frequency, urgency and possibly reduce recurrent urinary tract infections. Low-dose vaginal estrogen can be applied long-term in symptomatic women.
Is your skin losing its elasticity and do your joints ache more?
Estrogen treatment may have a protective effect against changes in connective tissue and may possibly reverse the negative effects of connective tissue loss in the skin, bones and joints.
Have a uterus and on Estrogen? You need to take Progestogen:
Women who still have their uterus and are receiving estrogen therapy should also take progestogen to avoid endometrial hyperplasia and endometrial cancer.
How often?
If the last menstrual period was less than one year prior to starting HRT, continues estrogen with progestogen for 12 to 14 days per month should be started. Women who do not wish to have a monthly withdrawal bleed may switch to a continuous combined regimen.
Postmenopausal bleeding:
If breakthrough bleeding occurs after continued combined HRT and does not stop after 3 to 6 months then sequential treatment for at least another year should be started again. If bleeding is heavy or irregular on a sequential regimen then the dose of progestogens can be doubled or increase the duration to 21 days. If bleeding continues after six months then pelvic ultrasound and/or endometrial biopsy should be considered.
How much HRT?
When prescribing HRT for the first time and in women over the age of 60, the lowest effective dose should be prescribed.
When deciding whether to use HRT, it is important to discuss personal and family history (re: breast, ovarian and uterine cancer) with your doctor and to receive sufficient information in order to make an educated choice.
If symptoms persist, the benefits of hormone therapy usually outweigh the risks.
Optimizing the Postmenopausal Years:
With a large percentage of the population aging, research and development towards improving hormonal preparations should continue to increase the benefits and minimize the side effects and risks of HRT. Ultimately this with proper diet and daily exercise will result in a better quality of life and help prevent long-term conditions such as osteoporosis, arthritis and memory loss which can result in increased personal, social and economic burden to society.

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