Role of progestogen in hormone therapy for postmenopausal XXXX : position statement of The North American Menopause Society.

@entity172 @entity1 @entity0 @entity548 @entity2588 @entity7828 @entity3942 @entity1869 @entity420 @entity65
OBJECTIVE: To create an evidence-based position statement regarding the role of progestogen in postmenopausal hormone therapy ( @entity172 plus a progestogen, or EPT) for the management of menopause-related symptoms. DESIGN: NAMS followed the general principles established for evidence-based guidelines to create this document. Clinicians and researchers acknowledged to be experts in the field of postmenopausal hormone therapy were enlisted to review the evidence obtained from the medical literature and develop a position statement for approval by the NAMS Board of Trustees. RESULTS: The primary role of progestogen in postmenopausal hormone therapy is endometrial protection. Unopposed @entity172 therapy (ET) is associated with a significantly increased risk of @entity1869 and @entity420 . Adding the appropriate dose and duration of progestogen to ET has been shown to lower that risk to the level found in never-users of ET. The clinical goal of progestogen in EPT is to provide endometrial protection while maintaining @entity172 benefits and minimizing progestogen-induced side effects, particularly uterine @entity548 . EPT discontinuance correlates with uterine @entity548 - @entity1 with more days of @entity2588 have higher rates of continuance. All US Food and Drug Administration-approved progestogen formulations will provide endometrial protection if the dose and duration are adequate. @entity7828 may diminish the beneficial effects of ET on cardiovascular risk factors. However, no EPT (or ET) regimen should be initiated for the primary or secondary prevention of @entity65 . Some @entity7828 may negatively affect mood. Adding progestogen to ET does not decrease the @entity0 risk, although it does not seem to increase mortality. Progestogen increases mammographic density, which is reversed after discontinuation of use. @entity3942 has limited effect on the bone-enhancing action of ET. In general, the side effects of added @entity3942 are mild, although they may be severe in a small percentage of @entity1 . CONCLUSIONS: Progestogen should be added to ET for all postmenopausal @entity1 with an intact uterus to prevent the elevated risk of @entity172 -induced @entity1869 and @entity420 . There is no consensus on a preferred regimen for all @entity1 . By changing the progestogen type, route, or regimen, clinicians can individualize therapy to minimize side effects, especially uterine @entity548 , and limit any effects on ET benefits while providing adequate endometrial protection.
