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Experts warn against HRT for menopausal depression in new guidance

Landmark guidance from Australia, designed to be implemented worldwide, and which has been endorsed by the International Menopause Society, recommends hormone replacement therapy not be prescribed for depression in women undergoing the “change of life”.

A growing number of women are turning to HRT to alleviate distressing menopause symptoms, with the number of HRT prescriptions having increased 47% compared to 2021/22, reports Daily Mail.

But experts who compiled the new menopause “toolkit” say clinical depression is not a condition that should simply be treated with hormones as a cure.

The guidance states that trials have found “no benefit of oestrogen therapy on depressive symptoms… over placebo”.

While the medication is recommended to ease physical symptoms like night sweats and hot flushes, clinical depression needs to be managed “in its own right”, and doctors should not assume depression in women of a certain age is caused by the menopause.

Professor Susan Davis, from Monash University in Australia, led development of the toolkit, which was presented in the journal Climacteric.

She said: “Menopause may cause symptoms such as low mood, anxiety, irritability and mood swings…it might exacerbate underlying depression but should not be assumed to be the cause of this.

“Low mood and anxiety or mood swings are common at menopause and most improve with oestrogen, so these are indications for menopausal hormone therapy.

“But clinical depression is not a condition that should simply be treated with hormones as a cure.”

The document, which replaces previous guidance released nearly 10 years ago, also suggests HRT does not improve learning, thinking or memory.

Study details

The 2023 Practitioner’s Toolkit for Managing Menopause

S. Davis, S. Taylor, F. Jane, et al.

Published in Climacteric on 30 October 2023

Abstract

Objective

The Practitioner’s Toolkit for Managing the Menopause, developed in 2014, provided an accessible desk-top tool for health-care practitioners caring for women at midlife. To ensure the Toolkit algorithms and supporting information reflect current best practice, the Toolkit has been revised in accordance with the published literature.

Methods
A systematic search for guidelines, position and consensus statements pertaining to the menopause and published after 2014 was undertaken, and key recommendations extracted from the Clinical Practice Guidelines determined to be the most robust by formal evaluation. The peer-reviewed literature was further searched for identified information gaps.

Results
The revised Toolkit provides algorithms that guide the clinical assessment and care of women relevant to menopause. Included are the reasons why women present, information that should be ascertained, issues that may influence shared decision-making and algorithms that assist with determination of menopausal status, menopause hormone therapy (MHT) and non-hormonal treatment options for symptom relief. As clear guidelines regarding when MHT might be indicated to prevent bone loss and subsequent osteoporosis in asymptomatic women were found to be lacking, the Toolkit has been expanded to support shared decision-making regarding bone health.

Conclusions
The 2023 Toolkit and supporting document provide accessible desk-top information to support health-care providers caring for women at midlife.

The Toolkit has been endorsed by the International Menopause Society, Australasian Menopause Society, British Menopause Society, Endocrine Society of Australia and Jean Hailes for Women’s Health.

 

Climacteric article – The 2023 Practitioner’s Toolkit for Managing Menopause (Open access)

 

Daily Mail article – Menopausal women should not be given HRT to treat depression, guidance says as prescriptions soar (Open access)

 

See more from MedicalBrief archives:

 

HRT should be given earlier as menopause ‘reshapes the brainʼ – Nature Scientific Reports

 

Half an hour of physical activity reduces depression risk – SA study

 

Education needed regarding efficacy of HRT for most women

 

The evidence base for HRT: What can we believe?

 

Hormone therapy for menopause symptoms: two decades on, the fear of risks persist

 

 

 

 

 

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