The latest thinking in menopause hormone therapy is the theme of this month’s World Menopause Day. The aim of the day is to raise awareness of the menopause to support and promote the wellbeing of women.

In tandem with this, the International Menopause Society (IMS) has published a White Paper addressing the key controversies in the area of menopause. This has been produced by an international multi-disciplinary group.

The White Paper set out to provide a well-balanced educational overview of menopause and hormone therapy. This looked at the anthropological background and the history of the menopause. It also examined the principles and controversies around hormone replacement therapy.

The publication lays the groundwork for forthcoming updated IMS recommendations on the menopause. An important section deals with hormone prescribing and discusses types and doses; when medication should be started and stopped; and why medication is important. It also examines the key question of access to therapy.

The mission of the IMS is to work globally to promote and support access to best practice health care for women through their menopause transition and post-reproductive years, enabling them to achieve this with optimal health and well-being. 

The paper states: “At present, conventionally licensed body-identical menopause hormone therapy (MHT) appears to offer some advantages over conjugated oestrogens and synthetic androgenic progestogens. It is disappointing that regulatory guidance does not recognise the differences in biological and clinical effects with more ‘natural’ types of conventionally regulated MHT. 

“Expanded funding of menopause research is critical to further evaluate the benefits and safety of modern types of MHT and to develop and identify novel treatment options that minimise adverse effects and maximise benefits. A key priority in research is critically evaluating the notion perpetrated by some agencies and media that all types of MHT have an identical impact on menopause related health issues.

“Whilst the recent focus has been on empowering women to proactively manage their distressing menopause symptoms, it is also important to promote a positive view of menopause as a natural stage in a woman’s life and an opportunity to re-evaluate and address current and future health concern.”

The White Paper points out that while regulatory authorities like the European Medicines Agency recommend that hormone therapy be used at the lowest dose for the shortest duration to relieve symptoms, the IMS suggests that there are no reasons to put limitations on the duration of therapy.

“Whether or not to continue therapy should be decided at the discretion of the well-informed woman and her healthcare professional, dependent upon the specific goals and an objective estimation of ongoing individual benefits and risks”.

The Irish College of GPs has a guideline on ‘Diagnosis and management of menopause in general practice’ which can be accessed in the clinical hub of the College website, irishcollegeofgps.ie