This is the current release of the guideline.

Estrogen and progestogen therapy

Management
Prevention

Family Practice
Internal Medicine
Obstetrics and Gynecology

Physicians

To present recommendations for the use of hormone therapy to treat or prevent problems associated with the decline of estrogen production by the ovaries after menopause

Postmenopausal women

1. Estrogen alone therapy (EP)
2. Estrogen combined with progesterone therapy (E/PT)

• Cessation of symptoms associated with estrogen depletion
• Adverse effects associated with hormone therapy

Searches of Electronic Databases

Not stated

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Not applicable

Review

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Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Internal Peer Review

The Practice Committee of the American Society for Reproductive Medicine and the Board of Directors of the American Society for Reproductive Medicine approved this report.

• Hot flushes occur in over 50% of women entering the menopause and the frequency declines to 30% after three years. Symptoms may persist, however, in up to 16% of women at 67 years of age.
• The usual reason for prescribing hormone therapy (HT) is the treatment of vasomotor symptoms. The average patient is a woman aged 45 to 60 years, and the most common duration of use is less than three years.
• Estrogen with or without progestogen is an effective treatment for urogenital atrophy, but may worsen urinary incontinence.
• Estrogen and progestogen reduce risk of osteoporotic fractures of the hip, vertebrae, and other sites, but the effect on hip fracture is small, and HT treatment is not warranted solely for fracture prevention.
• Although estrogen was associated with a 34% reduction in the risk of senile dementia in epidemiological studies, the Women's Health Initiative Memory Study (WHIMS) failed to corroborate these observations.
• HT is not indicated for the primary or secondary prevention of coronary artery disease events. Alternative health strategies and pharmaceutical agents with established value should be used for primary prevention of coronary heart disease.
• Risk of venous thromboembolism is increased among women using estrogen/progestogen therapy (E/PT) and declines during continuing use. Route of administration may affect the magnitude of risk.
• E/PT treatment has a small but significant effect on breast cancer risk equivalent to eight new cases per annum per 10,000 women. The increased risk is seen after five years of current use and disappears several years after discontinuing therapy.
• Epidemiological studies suggest that there is a small but significant increased risk of epithelial ovarian cancer with unopposed estrogen use that is not observed when estrogen is combined with progestin. The effect is significant in women who take ET for 10 or more years.
• ET and E/PT are associated with side effects that include breast tenderness, vaginal discharge, and uterine bleeding.
• The current indications for ET and E/PT include the treatment of moderate to severe vasomotor symptoms, the treatment of vulvar and vaginal atrophy, and the prevention of osteoporosis.

None provided

The type of supporting evidence is not specifically stated for each recommendation.

• Reduce symptoms resulting from estrogen depletion, including hot flushes, sleeplessness, lethargy, depressed mood, and vaginal dryness
• Treat urogenital atrophy
• Prevent osteoporosis

• Estrogen therapy (ET) and estrogen/progestogen therapy (E/PT) are associated with side effects that include breast tenderness, vaginal discharge, and uterine bleeding.
• Risk of venous thromboembolism is increased among women using estrogen/progestogen therapy (E/PT) and declines during continuing use. Route of administration may affect the magnitude of risk.
• E/PT treatment has a small but significant effect on breast cancer risk equivalent to eight new cases per annum per 10,000 women. The increased risk is seen after five years of current use and disappears several years after discontinuing therapy.

While this document reflects appropriate management of a problem encountered in the practice of reproductive medicine, it is not intended to be the only approved standard of practice or to dictate an exclusive course of treatment. Other plans of management may be appropriate, taking into account the needs of the individual patient, available resources, and institutional or clinical practice limitations.

An implementation strategy was not provided.

Getting Better
Staying Healthy

Effectiveness
Patient-centeredness

Not applicable: The guideline was not adapted from another source.

2004 Jan

American Society for Reproductive Medicine - Private Nonprofit Organization

American Society for Reproductive Medicine

The Practice Committee of the American Society for Reproductive Medicine

Not stated

Not stated

This is the current release of the guideline.

None available

None available

This NGC summary was completed by ECRI on August 23, 2004.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.