In reply: All menopausal hormone therapy is not alike

I appreciate the response from Dr. Lindner to my Medical Grand Rounds article about the global prevalence and management of primary ovarian insufficency.¹ Dr. Lindner’s letter cites the published indications and contraindications for menopausal hormone therapy. I would like to take this opportunity to clarify my article’s position that history of hormonally sensitive cancer in general and breast cancer specifically is an absolute contraindication to such treatment. The article discusses a role for menopausal hormone therapy in young women with primary ovarian insufficiency who have no familial or genetic elevated risk for breast cancer and no personal history of breast cancer, with the goal of emphasizing—and I believe Dr. Lindner and I are in agreement on this—that there is no strong evidence in the published literature suggesting that long-term use of menopausal hormone therapy in this population is associated with an elevated risk of breast cancer. I value Dr. Lindner’s points and support of the article’s emphasis on using the best evidence for clinical practice that does not deprive women of safe and effective treatments designed to promote quality of life and mitigate cardiovascular morbidity and mortality.

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