There is no doubt that future drugs being developed for postmenopausal prevention and treatment of disease will be undergoing intense scrutiny by the FDA, the medical community and consumers.
THE FUTURE
There
is no doubt that future drugs being developed for postmenopausal prevention
and treatment of disease will be undergoing intense scrutiny by the FDA, the
medical community and consumers. Each of these groups is better informed now
than in the mid-1990s, and as new replacements for oestrogen therapy (such as
new oestrogen receptor modulators or SERMS) are explored, the lessons of HT
will remain in the forefront, influencing the way future drugs are developed,
approved, marketed and prescribed.
Several
professional societies have weighed in on these issues (and continue to do so).
The American College of Obstetricians and Gynecologists (ACOG), for example,
formed a task force to examine the evidence from WHI and other studies and in
2004 issued the following statement: ‘The risks of HT exceed the benefits for
the prevention of chronic diseases in postmenopausal women. Hormone ther-apy
remains an effective therapy for treating women with vasomotor symptoms and
vaginal atrophy.’ The ACOG task force went on to state that
The use of HT for
specific indications, for exam-ple, treatment of menopausal symptoms or
treatment of osteoporosis, will require balancing the known benefits of HT in
treating these conditions with the known or potential risks of HT, as well as
balancing the benefits and risks of alternatives to HT. Clearly, healthy
symptomatic women who choose to use the most effective treatment for menopausal
symptoms, that is, HT, should not be denied this option based on available data
regarding health risks (ACOG, 2004).
The
EMAS has also carefully weighed the risk/benefit ratio of HT and has revised
their earlier recommendation statements for clinical practitioners regarding
peri- and postmenopausal HT to reflect the changing state of research following
WHI (EMAS 2005; Neves-e-Castro et al.,
2002).
As
noted by the ACOG HT Task Force (2004) and by others, ‘Virtually all
medications carry risks as well as benefits, and as detailed in the preceding
chapters, HT is no exception. Balancing these beneficial and harmful effects is
a challenging but important task for making informed decisions about the
prescribing and use of HT.’ Despite the many questions answered by WHI and the
even more questions raised by this study, it is clear that professional
societies in both Europe and the US feel that there is no one solution for all
postmenopausal women. It is also true that one piece of clarity in all of this
controversy is that the WHI has paved the way for more open communication
between the postmenopausal women and her health care provider. That is most certainly a good thing.
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