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Endocrine Abstracts (2018) 59 CMW4.2 | DOI: 10.1530/endoabs.59.CMW4.2

1British Menopause Society Board of Trustees, London, UK; 2Daisy Network Board of Trustees, London, UK.


The National Institute of Clinical Excellence (NICE) Menopause Clinical Guidelines, November 2015, has reinstated Hormone Replacement Therapy (HRT) for the average fit & healthy woman in her fifties, the clinical model used. Some women require alternatives for either medical or personal reasons,. Few complementary and alternative treatment options have evidence of efficacy yet several are mentioned by NICE as having possible roles. In symptomatic women with a contra-indication to estrogen progestogens have been a popular alternative to HRT. Some randomised controlled trials (RCT) show a modest benefit over placebo, but effective doses carry an increased risk of venous thrombo-embolism. The increased risk of breast cancer seen in combined HRT, and not estrogen alone, suggests a role in causation although, progestogens behave differently in breast tissues; it is not a class effect. Women often use complementary therapies as they are perceived to be safe alternatives to HRT. However, drug interactions and side-effects, especially St Johns Wort, calls this into question. The current regulation of complementary and alternative medicine is inadequate. A European Union Directive implemented in the UK in Oct 2005 on traditional herbal medicinal products does not cover products bought elsewhere. Phyto-estrogens either from Soy or Red Clover sources have the best evidence base and have been subjected to a Cochran Database Review. Non-hormonal prescribables include Clonidine (the only one licensed for vasomotor control), Gabapentin, Selective Serotonin re-uptake inhibitors (SSRIs) and Serotonin Nor-adrenaline re-uptake inhibitors (SNRIs). SSRIs have the potential to interact with Tamoxifen and adversely effect libido more than SNRIs. RCT data shows a small benefit, but in short duration trials with low numbers. Clinicians need familiarity with non-hormonal treatments to inform and guide women as to which options are most beneficial for them.

Volume 59

Society for Endocrinology BES 2018

Glasgow, UK
19 Nov 2018 - 21 Nov 2018

Society for Endocrinology 

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