Menopausal hormone therapy (August 2016)
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* Holly L. Thacker

**TO THE EDITOR**: I much enjoyed the important article by Drs. Lipold, Batur, and Kagan on whether there is a time limit for systemic menopausal hormone therapy.1 The simple answer is no. The authors did a good job of reviewing the factors to consider in terms of contraindications and precautions when prescribing menopausal hormone therapy.

An important part of the discussion regarding stopping hormone therapy is the recent evidence from Finland that has shown increased risks of myocardial infarction and stroke, especially in women under age 60, when taken off hormone therapy.2 This fact is quite ironic, as many clinicians are trying to rush to get women off hormone therapy in order to protect the heart, when the evidence does not suggest this. Just as with other hormone-deficiency conditions, the status needs to be periodically reviewed, and doses may need to be adjusted. However, after age 60 or 65, women do not automatically start producing the sex hormone that they have been deficient in. While menopause is not a definite endocrinopathy, it is a potential endocrinopathy; and for some women, such as young women who are oophorectomized, it is an absolute endocrinopathy.

The International Menopause Society has published updated guidelines emphasizing that new data and reanalysis of older data show that for most women the benefits of menopausal hormone therapy are much greater than the risks, particularly when started within a few years of menopause.3

*   Copyright © 2016 The Cleveland Clinic Foundation. All Rights Reserved.

## REFERENCES

1.  Lipold LD, Batur P, Kagan R. Is there a time limit for systemic menopausal hormone therapy? Cleve Clin J Med 2016; 83:605–612.
    
    [Abstract/FREE Full Text](http://www.ccjm.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NToiY2Nqb20iO3M6NToicmVzaWQiO3M6ODoiODMvOC82MDUiO3M6NDoiYXRvbSI7czoyMzoiL2Njam9tLzgzLzExLzc3OC4xLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

2.  Mikkola TS, Tuomikoski P, Lyytinen H, et al. Increased cardiovascular mortality risk in women discontinuing postmenopausal hormone therapy. J Clin Endocrinol Metab 2015; 100:4588–4594.
    
    [CrossRef](http://www.ccjm.org/lookup/external-ref?access_num=10.1210/jc.2015-1864&link_type=DOI) 
    
    [PubMed](http://www.ccjm.org/lookup/external-ref?access_num=26414962&link_type=MED&atom=%2Fccjom%2F83%2F11%2F778.1.atom) 

3.  Baber RJ, Panay N, Fenton A, IMS Writing Group. 2016 IMS recommendations on women’s midlife health and menopause hormone therapy. Climacteric 2016; 19:109–150.
    
    [CrossRef](http://www.ccjm.org/lookup/external-ref?access_num=10.3109/13697137.2015.1129166&link_type=DOI) 
    
    [PubMed](http://www.ccjm.org/lookup/external-ref?access_num=26872610&link_type=MED&atom=%2Fccjom%2F83%2F11%2F778.1.atom)