Global consensus statement on menopausal hormone therapy – an update

The Global Consensus statement published in this issue of Climacteric takes us forward from the first consensus document of 2013^1,2. That initial publication marked a unique time in menopause medicine when all major societies came together with a unified statement about the use of hormone therapy after menopause. It signalled increased clarity in our understanding of the risks and benefits of menopausal hormone therapy (MHT) – an understanding that had been so affected by the controversy surrounding the Women’s Health Initiative study³.

The 2016 revision has been endorsed by The International Menopause Society, The North American Menopause Society, The Endocrine Society, The European Menopause and Andropause Society, The Asia Pacific Menopause Federation, The International Osteoporosis Foundation and The Federation of Latin American Menopause Societies. It will be published simultaneously in Climacteric and in Maturitas, the journal of The European Menopause and Andropause Society. It follows very appropriately the detailed and fully referenced Recommendations on Women’s Midlife Health and Menopause Hormone Therapy published in the February issue of Climacteric⁴.

So what has been included in the most recent statement?

• The role and safety of tibolone, ospemifene and the tissue selective estrogen complex (TSEC) comprising conjugated estrogens and bazedoxifene. This recognizes the increasing complexity of therapeutic options;

• The role of alternative prescription therapies for menopausal symptoms;

• More detailed statements about fracture risk reduction;

• More detailed statements about the use of MHT in women with premature ovarian insufficiency or early menopause;

• Further information about the impact of MHT on mood changes at menopause;

• Broad statements on the overall management of midlife women’s health.

There is a concise section covering the principles of MHT use and this should be compulsory reading for all practitioners. It again reinforces the primary aim of therapy with the following statements: 'The type and route of administration of MHT should be consistent with treatment goals, patient preference and safety issues and should be individualized …. Duration of treatment should be consistent with the treatment goals of the individual.' This brings the focus back on the needs of the individual woman and away from blanket statements of 'lowest dose for the shortest period of time'.

The consensus we now have in this area of medicine is beginning to impact on practice across the globe. The National Institute for Health and Clinical Excellence (NICE) has issued recent Recommendations that help guide practitioners not just in the UK but across the world⁵; we are seeing increased access in some countries to fully subsidized hormone therapies, new therapies are emerging and new research has supported the safe use of MHT in younger women at menopause. In addition, these Consensus Statements mean that policy makers can no longer use a lack of clarity as an excuse for inaction. We have achieved some of the goals set out in our Editorial that accompanied the 2013 Consensus Statement⁶. However, we have a long way to go. There are still significant gaps in our knowledge, and the media and those writing Review articles in medical journals continue, at times, to take views that are contrary to the evidence. This creates a confusing environment for women, who, at the end of the day, are who we are trying to support.

The 2016 Consensus Statement brings great clarity to menopause medicine. Our next steps are to ensure that appropriate resources are made available for managing midlife women’s care, that prescribers have confidence that there is a range of effective and safe therapies for managing symptoms at menopause, and that funding is provided for high-quality research. We have a much greater chance of achieving these goals with collaborative efforts between respected medical societies.