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Mendoza N, Ramírez I, de la Viuda E, Coronado P, Baquedano L, Llaneza P, Nieto V, Otero B, Sánchez-Méndez S, de Frutos VÁ, Andraca L, Barriga P, Benítez Z, Bombas T, Cancelo MJ, Cano A, Branco CC, Correa M, Doval JL, Fasero M, Fiol G, Garello NC, Genazzani AR, Gómez AI, Gómez MÁ, González S, Goulis DG, Guinot M, Hernández LR, Herrero S, Iglesias E, Jurado AR, Lete I, Lubián D, Martínez M, Nieto A, Nieto L, Palacios S, Pedreira M, Pérez-Campos E, Plá MJ, Presa J, Quereda F, Ribes M, Romero P, Roca B, Sánchez-Capilla A, Sánchez-Borrego R, Santaballa A, Santamaría A, Simoncini T, Tinahones F, Calaf J. Eligibility criteria for Menopausal Hormone Therapy (MHT): a position statement from a consortium of scientific societies for the use of MHT in women with medical conditions. MHT Eligibility Criteria Group. Maturitas 2022; 166:65-85. [PMID: 36081216 DOI: 10.1016/j.maturitas.2022.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/21/2022] [Accepted: 08/17/2022] [Indexed: 11/26/2022]
Abstract
This project aims to develop eligibility criteria for menopausal hormone therapy (MHT). The tool should be similar to those already established for contraception A consortium of scientific societies coordinated by the Spanish Menopause Society met to formulate recommendations for the use of MHT by women with medical conditions based on the best available evidence. The project was developed in two phases. As a first step, we conducted 14 systematic reviews and 32 metanalyses on the safety of MHT (in nine areas: age, time of menopause onset, treatment duration, women with thrombotic risk, women with a personal history of cardiovascular disease, women with metabolic syndrome, women with gastrointestinal diseases, survivors of breast cancer or of other cancers, and women who smoke) and on the most relevant pharmacological interactions with MHT. These systematic reviews and metanalyses helped inform a structured process in which a panel of experts defined the eligibility criteria according to a specific framework, which facilitated the discussion and development process. To unify the proposal, the following eligibility criteria have been defined in accordance with the WHO international nomenclature for the different alternatives for MHT (category 1, no restriction on the use of MHT; category 2, the benefits outweigh the risks; category 3, the risks generally outweigh the benefits; category 4, MHT should not be used). Quality was classified as high, moderate, low or very low, based on several factors (including risk of bias, inaccuracy, inconsistency, lack of directionality and publication bias). When no direct evidence was identified, but plausibility, clinical experience or indirect evidence were available, "Expert opinion" was categorized. For the first time, a set of eligibility criteria, based on clinical evidence and developed according to the most rigorous methodological tools, has been defined. This will provide health professionals with a powerful decision-making tool that can be used to manage menopausal symptoms.
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Affiliation(s)
- Nicolás Mendoza
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain.
| | - Isabel Ramírez
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | | | - Pluvio Coronado
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Laura Baquedano
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Plácido Llaneza
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Verónica Nieto
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Borja Otero
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | | | | | - Leire Andraca
- Sociedad Española de Farmacia Comunitaria (SEFAC), Spain
| | | | - Zully Benítez
- Federación Latino Americana de Sociedades de Climaterio y Menopausia (FLASCYM)
| | - Teresa Bombas
- Red Iberoamericana de Salud Sexual y Reproductiva (REDISSER)
| | | | - Antonio Cano
- European Menopause and Andropause Society (EMAS)
| | | | | | - José Luis Doval
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - María Fasero
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Gabriel Fiol
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Nestor C Garello
- Federación Latino-Americana de Sociedades de Obstetricia y Ginecología (FLASOG)
| | | | - Ana Isabel Gómez
- Sociedad Española de Senología y Patología Mamaria (SESPM), Spain
| | - Mª Ángeles Gómez
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Silvia González
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | | | | | | | - Sonia Herrero
- Sociedad Española de Trombosis y Hemostasia (SETH), Spain
| | - Eva Iglesias
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Ana Rosa Jurado
- Sociedad Española de Médicos de Atención Primaria (SEMERGEN), Spain
| | - Iñaki Lete
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Daniel Lubián
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | | | - Aníbal Nieto
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Laura Nieto
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | | | | | | | | | - Jesús Presa
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | | | - Miriam Ribes
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Pablo Romero
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Beatriz Roca
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | | | | | | | | | | | | | - Joaquín Calaf
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
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Benkhadra K, Mohammed K, Al Nofal A, Carranza Leon BG, Alahdab F, Faubion S, Montori VM, Abu Dabrh AM, Zúñiga Hernández JA, Prokop LJ, Murad MH. Menopausal Hormone Therapy and Mortality: A Systematic Review and Meta-Analysis. J Clin Endocrinol Metab 2015; 100:4021-8. [PMID: 26544652 DOI: 10.1210/jc.2015-2238] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
OBJECTIVES The objective was to assess the effect of menopausal hormonal therapy (MHT) on all-cause and cause-specific mortality. METHODS We conducted a comprehensive search of several databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, and Scopus) from inception until August 2013. We included randomized controlled trials (RCTs) of more than 6 months of duration comparing MHT with no treatment. Pairs of independent reviewers selected trials, assessed risk of bias and extracted data. We estimated risk ratios (RRs) and 95% confidence intervals (CIs) using the random-effects model. RESULTS We included 43 RCTs at moderate risk of bias. Meta-analysis showed no effect on mortality (RR 0.99 [95% CI, 0.94-1.05]), regardless of MHT type or history of preexisting heart disease. No association was found between MHT and cardiac death (RR 1.04 [95% CI 0.87-1.23]) or stroke (RR 1.49 [95% CI 0.95-2.31]). Estrogen plus progesterone use was associated with a likely increase in breast cancer mortality (RR 1.96 [95% CI 0.98-3.94]), whereas estrogen use was not. MHT use was not associated with mortality of other types of cancer. In 5 trials, MHT was likely started at a younger age: 2 RCTs with mean age less than 60 and 3 RCTs with MHT started less than 10 years after menopause. Meta-analysis of these 5 RCTs showed a reduction of mortality with MHT (RR 0.70 [95% CI 0.52-0.95]). CONCLUSION The current evidence suggests that MHT does not affect the risk of death from all causes, cardiac death and death from stroke or cancer. These data may be used to support clinical and policy deliberations about the role of MHT in the care of symptomatic postmenopausal women.
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Affiliation(s)
- Khalid Benkhadra
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
| | - Khaled Mohammed
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
| | - Alaa Al Nofal
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
| | - Barbara G Carranza Leon
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
| | - Fares Alahdab
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
| | - Stephanie Faubion
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
| | - Victor M Montori
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
| | - Abd Moain Abu Dabrh
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
| | - Jorge Alberto Zúñiga Hernández
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
| | - Larry J Prokop
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
| | - Mohammad Hassan Murad
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
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