Revised global consensus statement on menopausal hormone therapy

Includes specific consensus on role of MHT in regard to bone loss and osteoporosis-related fractures in postmenopausal women.

The newly revised consensus statement serves to update and expand the areas of consensus following the publication of the Global Consensus on Menopausal Hormone Therapy (MHT) by leading global menopause societies in 2013. At the time, the Global Consensus succeeded in presenting guidelines that have been helpful to both healthcare providers and potential users of MHT.

The Revised Global Consensus on Menopausal Hormone Therapy, published in the journals Climacteric and Maturitas, has been authored by the following societies: the International Menopause Society, Endocrine Society, North American Menopause Society, European Menopause and Andropause Society, Asia Pacific Menopause Federation, Federation of Latin American Menopause Societies, and the International Osteoporosis Foundation.

The role of MHT in bone loss and osteoporosis-related fracture

Covering key areas of consensus on the benefit/risk profile of MHT and the general principles governing the use of MHT, the Statement also includes the following consensus in regard to bone loss and osteoporosis-related fracture:

  • MHT, including tibolone and conjugated equine estrogens/bazedoxifene (CE/BZA), is effective in the prevention of bone loss in postmenopausal women;
  • MHT has been shown to significantly lower the risk of hip, vertebral and other osteoporosis-related fractures in postmenopausal women;
  • MHT is the only therapy available with randomized controlled trials (RCT)-proven efficacy of fracture reduction in a group of postmenopausal women not selected for being at risk of fracture and with mean T-scores in the normal to osteopenic range;
  • MHT, including tibolone, can be initiated in postmenopausal women at risk of fracture or osteoporosis before the age of 60 years or within 10 years after menopause;
  • Initiation of MHT after the age of 60 years for the indication of fracture prevention is considered second-line therapy and requires individually calculated benefit/risk, compared to other approved drugs. If MHT is elected, the lowest effective dose should be used.

In terms of the general principles governing the use of MHT, the Consensus also states (among other consensus statements), that:

  • Consideration of MHT for symptom relief or osteoporosis prevention should be a part of an overall strategy including lifestyle recommendations regarding diet, exercise, smoking cessation and safe levels of alcohol consumption for maintaining the health and quality of life of peri- and postmenopausal women;
  • The option of MHT is an individual decision in terms of quality of life and health priorities as well as personal risk factors such as age, time since menopause and the risk of  venous thromboembolism (VTE), stroke, ischemic heart disease and breast cancer. MHT should not be recommended without a clear indication for its use.

It should be noted that the revised statement contains only areas of consensus and does not replace the more detailed and fully referenced recommendations of the individual societies.

> View the complete Statement: T. J. de Villiers, J. E. Hall, J. V. Pinkerton, S. Cerdas Pérez, M. Rees, C. Yang & D. D. Pierroz (2016): Revised Global Consensus Statement on Menopausal Hormone Therapy, Climacteric,
DOI: 10.1080/13697137.2016.1196047