Hormone replacement therapy: is it recommended by SBC guidelines or not?

Fuchs, Flávio Danni

doi:10.1590/S0066-782X2010001500019

Hormone replacement therapy; guidelines

LETTER TO THE EDITOR

Hospital de Clínicas de Porto Alegre, UFRGS

Mailing address

Keywords: Hormone replacement therapy; guidelines.

Guidelines for the use of hormone replacement therapy¹ have provoked controversy^2,3. The scientific debate is welcome, and I thank my colleagues for the elegant answer. I avoid extending the discussion to some counterpoints such as, for example, the assertion that in a post-hoc analysis of the WHI study no coronary risk was demonstrated in recent postmenopausal patients. If I had to comment on that statement, I would have noted that absence of risk is not synonymous of benefit, and that other risks of this therapy in recent postmenopausal patients have persisted in a recently published analysis⁴, such as the risk for stroke, thromboembolism, and breast cancer. My strongest divergence with the authors of the guideline (as they acknowledge in their comments) concerns the indication of hormone replacement therapy in the so-called window of opportunity. So I ask the authors of the guideline and of the point of view: What is their actual recommendation for patients in the so-called window of opportunity? Do they believe that "there is evidence of cardiovascular benefits when the HRT is initiated in the menopausal transition or in the early postmenopausal period (which is called window of opportunity) (Class IIa, Level of Evidence B)" (literally extracted from the guideline recommendation), or that "even at this stage, the HRT is not indicated for cardiovascular prevention"? (literally extracted from the point of view).

Clarification of this point may put an end in the controversy, if everyone agrees that hormone replacement therapy is not indicated for cardiovascular disease prevention in menopausal women, whether they are or they are not in windows of opportunity.

References

1. Sociedade Brasileira de Cardiologia. Associação Brasileira do Climatério. I Diretriz brasileira sobre prevenção de doenças cardiovasculares em mulheres climatéricas e a influência da terapia de reposição hormonal. Arq Bras Cardiol. 2008; 91 (1 supl.1): 1-23.
2. Fuchs FD. Ponto de vista - reposição hormonal e doença cardiovascular: uma diretriz contrária à evidência. Arq Bras Cardiol. 2009; 93 (1): e11-e13.
3. Gebara OC, Fernandes C, Bertolami MC. Prevenção de doenças cardiovasculares em mulheres climatéricas e a influência da terapia de reposição hormonal: uma diretriz baseada em evidências. Arq Bras Cardiol. 2009; 93 (5): e86-e88.
4. Prentice RL, Manson JE, Langer RD, Anderson GL, Pettinger M, Jackson RD, et al. Benefits and risks of postmenopausal hormone therapy when it is initiated soon after menopause. Am J Epidemiol. 2009; 170 (1): 12-23.