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Hillard T, Crowther N, Jaff N. Informal Invitation from Climacteric. Climacteric 2024; 27:226. [PMID: 38634465 DOI: 10.1080/13697137.2024.2343612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
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Lensen S, Paramanandam VS, Gabes M, Kann G, Donhauser T, Waters NF, Li AD, Peate M, Susanto NS, Caughey LE, Rangoonwal F, Liu J, Condron P, Anagnostis P, Archer DF, Avis NE, Bell RJ, Carpenter JS, Chedraui P, Christmas M, Davies M, Hillard T, Hunter MS, Iliodromiti S, Jaff NG, Jaisamrarn U, Joffe H, Khandelwal S, Kiesel L, Maki PM, Mishra GD, Nappi RE, Panay N, Pines A, Roberts H, Rozenberg S, Rueda C, Shifren J, Simon JA, Simpson P, Siregar MFG, Stute P, Garcia JT, Vincent AJ, Wolfman W, Hickey M. Recommended measurement instruments for menopausal vasomotor symptoms: the COMMA (Core Outcomes in Menopause) consortium. Menopause 2024:00042192-990000000-00324. [PMID: 38688464 DOI: 10.1097/gme.0000000000002370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
OBJECTIVE The aim of the study is to identify suitable definitions and patient-reported outcome measures (PROMs) to assess each of the six core outcomes previously identified through the COMMA (Core Outcomes in Menopause) global consensus process relating to vasomotor symptoms: frequency, severity, distress/bother/interference, impact on sleep, satisfaction with treatment, and side effects. METHODS A systematic review was conducted to identify relevant definitions for the outcome of side-effects and PROMs with acceptable measurement properties for the remaining five core outcomes. The consensus process, involving 36 participants from 16 countries, was conducted to review definitions and PROMs and make final recommendations for the measurement of each core outcome. RESULTS A total of 21,207 publications were screened from which 119 reporting on 40 PROMs were identified. Of these 40 PROMs, 36 either did not adequately map onto the core outcomes or lacked sufficient measurement properties. Therefore, only four PROMs corresponding to two of the six core outcomes were considered for recommendation. We recommend the Hot Flash Related Daily Interference Scale to measure the domain of distress, bother, or interference of vasomotor symptoms and to capture impact on sleep (one item in the Hot Flash Related Daily Interference Scale captures interference with sleep). Six definitions of "side effects" were identified and considered. We recommend that all trials report adverse events, which is a requirement of Good Clinical Practice. CONCLUSIONS We identified suitable definitions and PROMs for only three of the six core outcomes. No suitable PROMs were found for the remaining three outcomes (frequency and severity of vasomotor symptoms and satisfaction with treatment). Future studies should develop and validate PROMs for these outcomes.
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Affiliation(s)
- Sarah Lensen
- From the Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | | | | | | | - Theresa Donhauser
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Niamh F Waters
- From the Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Anna D Li
- From the Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Michelle Peate
- From the Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Nipuni S Susanto
- From the Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Lucy E Caughey
- From the Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Fatema Rangoonwal
- From the Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Jingbo Liu
- From the Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Patrick Condron
- University Library, The University of Melbourne, Parkville, Australia
| | - Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, 1 Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - David F Archer
- Department of Obstetrics and Gynaecology, Eastern Virginia Medical School, Norfolk, VA
| | - Nancy E Avis
- Wake Forest University School of Medicine, Winston-Salem, NC
| | - Robin J Bell
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Peter Chedraui
- Escuela de Posgrado en Salud, Universidad Espíritu Santo, Samborondón, Ecuador
| | - Monica Christmas
- Department of Obstetrics and Gynaecology, University of Chicago, Chicago, IL
| | - Melanie Davies
- Institute for Women's Health, University College London, UK
| | - Tim Hillard
- Department of Obstetrics and Gynaecology, University Hospitals Dorset NHS Trust, Poole, Dorset, UK
| | - Myra S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stamatina Iliodromiti
- Women's Health Research Unit, Wolfson Institute of Population Health, QMUL, London, United Kingdom
| | - Nicole G Jaff
- Department of Chemical Pathology, National Health Laboratory Service and University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Unnop Jaisamrarn
- Center of Excellence in Menopause and Aging Women Health, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Hadine Joffe
- Connors Center for Women's Health and Gender Biology and the Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sunila Khandelwal
- Department of Obstetrics and Gynaecology, Fortis Escort Hospital, Jaipur, India
| | - Ludwig Kiesel
- Department of Gynaecology and Obstetrics, University of Muenster, Germany
| | - Pauline M Maki
- University of Illinois at Chicago, Departments of Psychiatry, Psychology and Obstetrics and Gynecology, Chicago, IL
| | - Gita D Mishra
- Australian Women and Girls' Health Research Centre, School of Public Health, University of Queensland, St Lucia, Australia
| | - Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
| | - Nick Panay
- Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
| | - Amos Pines
- Tel-Aviv University School of Medicine, Tel-Aviv, Israel
| | - Helen Roberts
- Menopause clinic, Te Toka Tumai, Auckland Hospital, Auckland, New Zealand
| | - Serge Rozenberg
- Department of Ob-Gyn CHU St Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Camilo Rueda
- University La Sábana, Country Clinic, Bogotá, Colombia
| | - Jan Shifren
- Midlife Women's Health Center, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - James A Simon
- Department of Obstetrics and Gynecology, George Washington University, Washington, DC
| | - Paul Simpson
- Department of Obstetrics & Gynaecology, Norfolk & Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Muhammad Fidel Ganis Siregar
- Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Sumatera Utara, Sumatera Utara, Indonesia
| | - Petra Stute
- Department of Obstetrics and Gynecology, University Clinic Inselspital, Bern, Switzerland
| | - Joan Tan Garcia
- Menopause Clinic, Department of Obstetrics & Gynecology, St Lukes Medical Center, Quezon City, Philippines
| | - Amanda J Vincent
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia
| | - Wendy Wolfman
- Department of Obstetrics and Gynaecology and Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Martha Hickey
- From the Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
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Hillard T. The next chapter. Climacteric 2024; 27:113-114. [PMID: 38470942 DOI: 10.1080/13697137.2024.2319513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
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Laing A, Thomas L, Hillard T, Panay N, Briggs P. Exploring the potential for a set of UK hormone replacement therapy eligibility guidelines: A suggested proposal on the topic of venous thromboembolism. Post Reprod Health 2024; 30:39-54. [PMID: 38149845 DOI: 10.1177/20533691231223682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
OBJECTIVE To explore the feasibility for a set of hormone replacement therapy (HRT) eligibility guidelines that follow a similar structure and appearance to the UKMEC guidance for contraception. To enable non-specialists to feel confident in safely prescribing HRT and to aid selection of the most appropriate first line treatment. METHODS A literature review was undertaken with evidence summarised on the topic of venous thromboembolism (VTE) which is an area frequently considered a barrier to prescribing. Medical eligibility tables which separated HRT by type were then produced for a set of VTE-related topics. RESULTS The literature search confirmed the importance of distinguishing between different types and routes of administration when considering the suitability of HRT. Much of the evidence has been based on older synthetic types of HRT and whilst they still have a role in management, these medications carry different risks to the now more accepted use of body identical types. The search also highlighted the nuances involved, increasing the complexity of forming guidelines, with the need for consideration to be given to an individual's own perception of risks and benefits. CONCLUSION The demand for HRT has risen in recent years and there is a need for this to be managed effectively, particularly for patients in primary care. The production of this type of guidance will enable the non-specialist to feel confident in safe and evidence-based prescribing. The guidelines are also designed to demonstrate to prescribers which complex patients should be referred onto menopause specialists.
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Affiliation(s)
- Abbie Laing
- Poole Menopause Centre University Hospitals Dorset, Poole, UK
| | - Lindsey Thomas
- Leeds Menopause Service, Meanwood Health Centre, Leeds, UK
| | - Tim Hillard
- Poole Menopause Centre University Hospitals Dorset, Poole, UK
| | - Nick Panay
- Imperial College Healthcare NHS Trust, UK
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Laing A, Hillard T. Oestrogen-based therapies for menopausal symptoms. Best Pract Res Clin Endocrinol Metab 2024; 38:101789. [PMID: 37453831 DOI: 10.1016/j.beem.2023.101789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
PURPOSE To summarise the dosing options, regimens, pharmacokinetics, risks and benefits of oestrogen-based therapies for the treatment of menopausal symptoms. METHODS A review of the literature was undertaken using multiple databases. Randomised trials, observational studies, meta-analyses and review papers were included. RESULTS Multiple systemic preparations of oestrogen exist and all appear comparable in terms of efficacy. They differ by pharmacokinetics and those preparations that avoid hepatic metabolism have a lower risk profile in general although their use can be limited by skin barriers or patient acceptability. All vaginal oestrogen treatments are comparable in efficacy and have not been associated with any health risks. Side-effects between all preparations differ. CONCLUSIONS With regards to oestrogen treatments there is not a one size fits all. Multiple treatments are available and a clinician's role is to guide and help women make evidence based, unbiased and informed choices.
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Affiliation(s)
- Abbie Laing
- Poole Menopause Centre, University Hospitals Dorset, Poole UK.
| | - Tim Hillard
- Poole Menopause Centre, University Hospitals Dorset, Poole UK.
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Robinson D, Hillard T. Professor Linda Cardozo OBE MB ChB MD FRCOG: 15.09.50-21.09.23. Climacteric 2023; 26:632-633. [PMID: 37997744 DOI: 10.1080/13697137.2023.2274189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Affiliation(s)
- Dudley Robinson
- Department of Urogynaecology, King's College Hospital, London, UK
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Robinson D, Hillard T. Professor Linda Cardozo OBE MB ChB MD FRCOG 15.09.50-21.09.23. Post Reprod Health 2023; 29:244-245. [PMID: 37992486 DOI: 10.1177/20533691231212798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
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Briggs P, Barber K, Cooke K, Hillard T, Mansour D, Panay N, Pearson K, Tanna N, Wokoma T. Consensus-led recommendations supporting choice and personalisation of Hormone replacement therapy in menopause care. Post Reprod Health 2022; 28:71-78. [PMID: 35443829 DOI: 10.1177/20533691221084827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Inequity of access and choice to different hormone replacement therapy (HRT) products across the UK has been suggested (Hillman, 2020). While, the cause is not entirely understood, potential contributors include conflicting national guidance, economic deprivation and a local formulary approach. With a diverse and growing population of women reaching and living well beyond the menopause, the impact of this inequity is becoming more pronounced, and challenges the goal of providing personalised care. The study objective is to establish a consensus that supports a greater equity of access and choice of HRT and provision of individualised care. STUDY DESIGN Modified Delphi study designed by UK HCPs with expertise in menopause care. This group identified 40 consensus statements over four key topics, related to access and choice of different HRT products. An online 4-point Likert scale questionnaire, sent to UK HCPs, was used to assess agreement, with a consensus threshold set at 75%. MAIN OUTCOME MEASURES 150 HCP responses between June and September 2021. RESULTS A total of 137 responses were received. Analysis identified 37/40 statements attaining very high agreement (≥ 90%) and 3/40 statements attaining high agreement (< 90% and ≥75%). Nine recommendations were developed with the intent to inform potential improvements to menopause care in the UK. CONCLUSIONS The high levels of agreement displayed suggest a desire to change the way menopause care is delivered in the UK. Implementation of the suggested recommendations has the potential to improve equity of access to licensed treatment options, compliant with the NICE recommendation for personalisation of care.
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Affiliation(s)
- Paula Briggs
- Consultant Sexual & Reproductive Health, 4592Liverpool Womens NHS Foundation Trust, Liverpool, UK
| | - Katie Barber
- General Practitioner with Extended Role in Menopause and Gynaecology, Woodlands Medical Centre, Oxford, UK
| | | | - Tim Hillard
- Consultant Gynaecologist, University Hospitals Dorset, Poole, UK
| | - Diana Mansour
- Consultant in Community Gynaecology & Reproductive Healthcare, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | | - Keith Pearson
- Head of Medicines Optimisation, NHS Heywood Middleton and Rochdale Clinical Commissioning Group, Manchester, UK
| | - Nuttan Tanna
- Pharmacist Consultant, Womens Services, London, UK
| | - Tonye Wokoma
- Consultant Community Sexual & Reproductive Health, City Healthcare Partnership, Hull, UK
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Lensen S, Bell RJ, Carpenter JS, Christmas M, Davis SR, Giblin K, Goldstein SR, Hillard T, Hunter MS, Iliodromiti S, Jaisamrarn U, Khandelwal S, Kiesel L, Kim BV, Lumsden MA, Maki PM, Mitchell CM, Nappi RE, Niederberger C, Panay N, Roberts H, Shifren J, Simon JA, Stute P, Vincent A, Wolfman W, Hickey M. A core outcome set for genitourinary symptoms associated with menopause: the COMMA (Core Outcomes in Menopause) global initiative. Menopause 2021; 28:859-866. [PMID: 33973541 DOI: 10.1097/gme.0000000000001788] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Genitourinary symptoms, such as vaginal dryness and pain with sex, are commonly experienced by postmenopausal women. Comparing treatments for these genitourinary symptoms are restricted by the use of different outcome measures in clinical trials and the omission of outcomes, which may be relevant to women. The aim of this project was to develop a Core Outcome Set (COS) to be reported in clinical trials of treatments for genitourinary symptoms associated with menopause. METHODS We performed a systematic review of randomized controlled trials of treatments for genitourinary symptoms associated with menopause and extracted their outcomes. This list was refined and entered into a two-round modified Delphi survey, which was open to clinicians, researchers, and postmenopausal women from November 2019 to March 2020. Outcomes were scored on a nine-point scale from "not important" to "critically important." The final COS was determined following two international consensus meetings. RESULTS A total of 26 unique outcomes were included in the Delphi process, which was completed by 227 participants of whom 58% were postmenopausal women, 34% clinicians, and 8% researchers. Predefined thresholds were applied to the Delphi scores to categorize outcomes by importance, which informed the e consensus meetings, attended by 43 participants from 21 countries. The final COS includes eight outcomes: (1) pain with sex, (2) vulvovaginal dryness, (3) vulvovaginal discomfort or irritation, (4) discomfort or pain when urinating, (5) change in most bothersome symptom, (6) distress, bother or interference of genitourinary symptoms, (7) satisfaction with treatment, (8) side effects of treatment. CONCLUSION These eight core outcomes reflect the joint priorities of postmenopausal women, clinicians, and researchers internationally. Standardized collection and reporting of these outcomes in clinical trials will facilitate the comparison of different treatments for genitourinary symptoms, advance clinical practice, and ultimately improve outcomes for symptomatic women.
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Affiliation(s)
- Sarah Lensen
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Robin J Bell
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University. Melbourne, Australia
| | | | - Monica Christmas
- Department of Obstetrics and Gynaecology, University of Chicago, Chicago, IL
| | - Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University. Melbourne, Australia
| | | | - Steven R Goldstein
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY
| | - Tim Hillard
- Department of Obstetrics and Gynaecology, University Hospitals Dorset NHS Trust, Poole, Dorset, UK
| | - Myra S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stamatina Iliodromiti
- Centre for Women's Health, Institute of Population Health Sciences, Queen Mary University London, UK
| | - Unnop Jaisamrarn
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sunila Khandelwal
- Department of Obstetrics and Gynaecology, Fortis Escort Hospital, Jaipur, India
| | - Ludwig Kiesel
- Department of Gynaecology and Obstetrics, University of Muenster, Muenster, Germany
| | - Bobae V Kim
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Mary Ann Lumsden
- Department of Reproductive and Maternal Medicine, School of Medicine, University of Glasgow, Glasgow, UK
| | - Pauline M Maki
- Departments of Psychiatry, Psychology and Obstetrics and Gynecology, University of Illinois at Chicago, Chicago IL
| | - Caroline M Mitchell
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA
| | - Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, University of Pavia, Pavia, Italy
| | | | - Nick Panay
- Queen Charlotte's and Chelsea and Westminster Hospitals, Imperial College London, London, UK
| | - Helen Roberts
- Auckland District Health Board, Auckland, New Zealand
| | - Jan Shifren
- Department of Obstetrics and Gynecology, Midlife Women's Health Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - James A Simon
- Department of Obstetrics and Gynecology, George Washington University, Washington, DC
| | - Petra Stute
- Department of Obstetrics and Gynecology, University Clinic Inselspital Bern, Bern, Switzerland
| | - Amanda Vincent
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Wendy Wolfman
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
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Lensen S, Archer D, Bell RJ, Carpenter JS, Christmas M, Davis SR, Giblin K, Goldstein SR, Hillard T, Hunter MS, Iliodromiti S, Jaisamrarn U, Joffe H, Khandelwal S, Kiesel L, Kim BV, Lambalk CB, Lumsden MA, Maki PM, Nappi RE, Panay N, Roberts H, Shifren J, Simon JA, Vincent A, Wolfman W, Hickey M. A core outcome set for vasomotor symptoms associated with menopause: the COMMA (Core Outcomes in Menopause) global initiative. Menopause 2021; 28:852-858. [PMID: 33906204 DOI: 10.1097/gme.0000000000001787] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Vasomotor symptoms (VMS) (hot flashes and night sweats) affect most women over the menopause transition. Comparing the safety and effectiveness of treatments for vasomotor symptoms is limited by the use of inconsistent outcome measures, and uncertainty as to which outcomes are most important to symptomatic women. To address this, we have developed a Core Outcome Set (COS) for use in clinical trials of treatments for VMS. METHODS We systematically reviewed the primary outcomes measured in randomized controlled trials of treatments for VMS. These were refined and entered into a two-round modified Delphi survey completed by clinicians, researchers, and postmenopausal women between November 2019 and March 2020. Outcomes were scored on a nine-point scale from "not important" to "critically important." Two international consensus meetings were held to finalize the COS. RESULTS Based on the systematic review, 13 separate outcomes were included in the Delphi process. This was completed by 227 participants of whom 58% were postmenopausal women, 34% clinicians, and 8% researchers. Predefined thresholds were applied to categorize importance scores obtained during Round 2 of the Delphi survey. These informed discussions at the consensus meetings which were attended by 56 participants from 28 countries. The final COS includes six outcomes: 1) frequency of VMS, 2) severity of VMS, 3) distress, bother or interference caused by VMS, 4) impact on sleep, 5) satisfaction with treatment, and 6) side-effects of treatment. CONCLUSION Implementation of this COS will: better enable research studies to accurately reflect the joint priorities of postmenopausal women, clinicians and researchers, standardize outcome reporting, and facilitate combining and comparing results from different studies, and ultimately improve outcomes for women with bothersome VMS.
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Affiliation(s)
- Sarah Lensen
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - David Archer
- Obstetrics and Gynaecology, Eastern Virginia Medical School, Norfolk, VA
| | - Robin J Bell
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Monica Christmas
- Department of Obstetrics and Gynaecology, University of Chicago, Chicago, IL
| | - Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Karen Giblin
- Red Hot Mamas North America, Inc, Town of Ridgefield, CT
| | - Steven R Goldstein
- Obstetrics and Gynecology, New York University School of Medicine, New York, NY
| | - Tim Hillard
- Department of Obstetrics and Gynaecology, University Hospitals Dorset NHS Trust, Poole, Dorset, UK
| | - Myra S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stamatina Iliodromiti
- Centre for Women's Health, Institute of Population Health Sciences, Queen Mary University London, London, UK
| | - Unnop Jaisamrarn
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Hadine Joffe
- Connors Center for Women's Health and Gender Biology and the Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sunila Khandelwal
- Department of Obstetrics and Gynaecology, Fortis Escort Hospital, Jaipur, India
| | - Ludwig Kiesel
- Department of Gynaecology and Obstetrics, University of Muenster, Muenster, Germany
| | - Bobae V Kim
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Cornelis B Lambalk
- Amsterdam Reproduction and Development, Center for Reproductive Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Mary Ann Lumsden
- Department of Reproductive and Maternal medicine, School of Medicine, University of Glasgow, Glasgow, UK
| | - Pauline M Maki
- University of Illinois at Chicago, Departments of Psychiatry, Psychology and Obstetrics and Gynecology, Chicago, IL
| | - Rossella E Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Nick Panay
- Queen Charlotte's and Chelsea and Chelsea and Westminster Hospitals, Imperial College London, London, UK
| | - Helen Roberts
- Auckland District Health Board, Auckland, New Zealand
| | - Jan Shifren
- Midlife Women's Health Center, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - James A Simon
- Department of Obstetrics and Gynecology, George Washington University, Washington, DC
| | - Amanda Vincent
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Wendy Wolfman
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
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Affiliation(s)
| | - Rod Baber
- ASSOCIATE EDITOR AND EDITOR-IN-CHIEF
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Hamoda H, Davis SR, Cano A, Morris E, Davison S, Panay N, Lumsden MA, Hillard T, Simoncini T. BMS, IMS, EMAS, RCOG and AMS joint statement on menopausal hormone therapy and breast cancer risk in response to EMA Pharmacovigilance Risk Assessment Committee recommendations in May 2020. Post Reprod Health 2021; 27:49-55. [PMID: 33459135 DOI: 10.1177/2053369120983154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Antonio Cano
- European Menopause and Andropause Society, Berlin, Germany
| | | | - Sonia Davison
- Australasian Menopause Society, Healesville, Australia
| | - Nicholas Panay
- Queen Charlotte's and Chelsea & Westminster Hospitals, London, UK
| | - Mary A Lumsden
- Glasgow Royal Infirmary, University of Glasgow, Glasgow, UK
| | - Tim Hillard
- Poole Hospital NHS Foundation Trust, Poole Hospital, Poole, UK
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Rozenberg S, Al-Daghri N, Aubertin-Leheudre M, Brandi ML, Cano A, Collins P, Cooper C, Genazzani AR, Hillard T, Kanis JA, Kaufman JM, Lambrinoudaki I, Laslop A, McCloskey E, Palacios S, Prieto-Alhambra D, Reginster JY, Rizzoli R, Rosano G, Trémollieres F, Harvey NC. Is there a role for menopausal hormone therapy in the management of postmenopausal osteoporosis? Osteoporos Int 2020; 31:2271-2286. [PMID: 32642851 PMCID: PMC7661391 DOI: 10.1007/s00198-020-05497-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/04/2020] [Indexed: 12/21/2022]
Abstract
We provide an evidence base and guidance for the use of menopausal hormone therapy (MHT) for the maintenance of skeletal health and prevention of future fractures in recently menopausal women. Despite controversy over associated side effects, which has limited its use in recent decades, the potential role for MHT soon after menopause in the management of postmenopausal osteoporosis is increasingly recognized. We present a narrative review of the benefits versus risks of using MHT in the management of postmenopausal osteoporosis. Current literature suggests robust anti-fracture efficacy of MHT in patients unselected for low BMD, regardless of concomitant use with progestogens, but with limited evidence of persisting skeletal benefits following cessation of therapy. Side effects include cardiovascular events, thromboembolic disease, stroke and breast cancer, but the benefit-risk profile differs according to the use of opposed versus unopposed oestrogens, type of oestrogen/progestogen, dose and route of delivery and, for cardiovascular events, timing of MHT use. Overall, the benefit-risk profile supports MHT treatment in women who have recently (< 10 years) become menopausal, who have menopausal symptoms and who are less than 60 years old, with a low baseline risk for adverse events. MHT should be considered as an option for the maintenance of skeletal health in women, specifically as an additional benefit in the context of treatment of menopausal symptoms, when commenced at the menopause, or shortly thereafter, in the context of a personalized benefit-risk evaluation.
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Affiliation(s)
- S Rozenberg
- Department of Obstetrics and Gynecology CHU St Pierre, Université Libre de Bruxelles, Vrije Universiteit, Brussels, Belgium
| | - N Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - M Aubertin-Leheudre
- Department of Physical Activity Sciences, Faculty of Sciences, Université du Québec à Montréal, CRIUGM, Montreal, Québec, Canada
| | - M-L Brandi
- Department of Biochemical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
- Unit of Bone and Mineral Diseases, University Hospital of Florence, Florence, Italy
| | - A Cano
- Department of Obstetrics and Gynecology, University of Valencia and INCLIVA Health Research Institute, Valencia, Spain
| | - P Collins
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton Hospital, Royal Brompton Campus, Sydney Street, London, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - A R Genazzani
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - T Hillard
- Department of Obstetrics & Gynaecology, Poole Hospital NHS Trust, Poole, UK
| | - J A Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
| | - J-M Kaufman
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - I Lambrinoudaki
- Menopause Unit, 2nd Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - A Laslop
- Scientific Office, Federal Office for Safety in Health Care, Vienna, Austria
| | - E McCloskey
- Centre for Integrated research in Musculoskeletal Ageing, Mellanby Centre for Bone Research, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - S Palacios
- Director of Palacios Institute of Women's Health, Madrid, Spain
| | - D Prieto-Alhambra
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J-Y Reginster
- WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liege, Belgium
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - R Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | - F Trémollieres
- Menopause Center, Hôpital Paule de Viguier, University Hospital of Toulouse and INSERM U1048-I2MC-Equipe 9, Toulouse, France
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK.
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14
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Abstract
OBJECTIVE Requests for management of menopausal symptoms and hormone replacement are increasing in the UK. Referrals to specialist clinics have to be balanced with increasing recommendations within the NHS to improve efficiency and patient care. STUDY DESIGN Retrospective evaluation of clinic records over two months at a district general (Poole Hospital) and tertiary (Guy's Hospital) menopause service. Data on referral origin, reason for referral, interval from referral to review and outcome were collected and compared between trusts. MAIN OUTCOME MEASURES To evaluate and compare referrals and outcomes in a tertiary and district general menopause service and provide recommendations for improving efficiency. RESULTS Most referrals are from primary care but up to 25% are from other specialties. Half of the appointments are new referrals and 95% of women attend. Of the new referrals, 50% have multiple medical comorbidities, 25% a personal or family history of cancer and 25% treatment resistance; 30% have premature ovarian insufficiency. At Guy's Hospital, 30% are reviewed more than 18 weeks after referral, at Poole Hospital this is 6%. Treatment resistance is reported in half of the women reviewed at follow-up. CONCLUSIONS Menopause services review a complex patient population and the majority of referred women have more than one co-morbidity; they require time, specialist knowledge of current treatment options and a multidisciplinary approach. The main barrier to service efficiency is capacity, particularly in population dense areas; cognitive behavioural therapy and non-hormonal methods appear under-utilised in primary care, as do alternative methods of follow-up within the clinics such as telephone and patient-initiated appointments.
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Affiliation(s)
- Kristyn M Manley
- Poole Hospital NHS Trust, Poole, UK.,Guy's and St Thomas' NHS Trust, London, UK
| | | | - D Holloway
- Guy's and St Thomas' NHS Trust, London, UK
| | - D Bruce
- Guy's and St Thomas' NHS Trust, London, UK
| | - J Rymer
- Guy's and St Thomas' NHS Trust, London, UK
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Phillips C, Hillard T, Salvatore S, Toozs-Hobson P, Cardozo L. Lasers in gynaecology. Eur J Obstet Gynecol Reprod Biol 2020; 251:146-155. [PMID: 32505055 DOI: 10.1016/j.ejogrb.2020.03.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 03/12/2020] [Accepted: 03/16/2020] [Indexed: 11/28/2022]
Abstract
The use of lasers to treat gynaecological and urogynaecological conditions including genitourinary syndrome of the menopause, stress urinary incontinence, vaginal prolapse and other conditions, has become increasingly popular over recent years. Following widespread concerns over the use of mesh for treating stress urinary incontinence and pelvic organ prolapse and potential adverse outcomes from the use of mesh, there has been heightened awareness and debate over the introduction and adoption of new technologies and interventions within the speciality. On July 30th 2018 the United States Food and Drug Administration (FDA) issued a warning against the use of energy based devices (EBDS) including laser to perform "vaginal rejuvenation" or vaginal cosmetic procedures. Numerous review articles and editorials have urged for greater evidence on the efficacy and safety of vaginal lasers This review outlines the evidence to date for the use of lasers in the treatment of gynaecological conditions.
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Affiliation(s)
- Christian Phillips
- Consultant Gynaecologist and Urogynaecologist, Hampshire Hospitals, Hampshire, UK; Visiting Professor, University of Winchester, Hampshire, UK.
| | - Tim Hillard
- Consultant Obstetrician and Gynaecologist, Poole Hospital NHS Foundation Trust, UK
| | - Stefano Salvatore
- Consultant Gynaecologist and Urogynaecologist, San Raffaele Hospital, Milan, Italy
| | - Phil Toozs-Hobson
- Consultant Gynaecologist and Urogynaecologist, Birmingham Women's Hospital, UK
| | - Linda Cardozo
- Consultant Gynaecologist and Urogynaecologist, Kings College Hospital, UK
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16
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Affiliation(s)
- Swati Jha
- Consultant Gynaecologist Subspecialist in Urogynaecology Sheffield Teaching Hospitals NHS Foundation Trust Level 4, Jessop Wing, Tree Root Walk Sheffield S10 2SF UK
| | - Tim Hillard
- Consultant Gynaecologist and Urogynaecologist Department of Obstetrics and Gynaecology Poole Hospital NHS Foundation Trust Longfleet Road Poole Dorset BH15 2JB UK
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Abstract
Introduction and hypothesis The aim of the British Society of Urogynaecology (BSUG) 2013 audit for stress urinary incontinence (SUI) surgery was to conduct a national clinical audit looking at the intra- and postoperative complications and provide outcomes for these procedures. This audit was supported by the Healthcare Quality Improvement Partnership (HQIP) and National Health Service (NHS) England. Methods Data were collected for all continence procedures performed in 2013 through the BSUG database. All clinicians in England performing SUI surgery were invited to submit data to a central database. Outcomes data for the different continence procedures were collected and included intraoperative and postoperative complications and the change in continence scores at postoperative follow-up Changing trends in stress incontinence surgery were also assessed. Results We recorded 4993 urinary incontinence procedures from 177 consultants at 110 centres in England: 94.6% were midurethral slings; 86.7% (4331) were submitted by BSUG members with the remaining 13.3% submitted by non-BSUG members. Postoperative follow-up data were available for 3983 (80%) patients: 92.3% (3676) were very much better/much better postoperatively, and 4806 (96.3%) proceeded with no reported complications. There were 187 cases (3.7%) in which a perioperative complication was recorded. Pain persisting >30 days was reported in 1.9% of all patients. Conclusions Surgery for SUI has good outcomes in the short term. Midurethral synthetic slings have been shown to be safe and effective as a treatment option, with >90% being very much/much better at their postoperative follow-up.
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Affiliation(s)
- Swati Jha
- Department of Urogynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Jessop Wing, Tree Root Walk, Sheffield, S10 2SF, UK.
| | - Tim Hillard
- Department of Obstetrics and Gynaecology, Poole Hospital NHS Foundation Trust, Longfleet Road, Poole, Dorset, BH15 2JB, UK
| | - Ash Monga
- Urogynaecology Unit, University Hospitals Southampton NHS Trust, Tremona Road, Southampton, SO16 6UY, UK
| | - Jonathan Duckett
- Department of Obstetrics and Gynaecology, Medway Hospital, Windmill Rd, Gillingham, Kent, ME7 5NY, UK
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Duckett J, Morley R, Monga A, Hillard T, Robinson D. Mesh removal after vaginal surgery: what happens in the UK? Int Urogynecol J 2016; 28:989-992. [PMID: 27924372 DOI: 10.1007/s00192-016-3217-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 11/15/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS There is little objective evidence regarding complication rates for mesh procedures outside clinical trials. Current coding poorly collects complications of prolapse and continence surgery using mesh. This survey was designed to identify surgeons performing mesh removal and reporting patterns in the UK. METHODS An electronic questionnaire was sent to all members of the Royal College of Obstetricians and Gynaecologists and members of the Section of Female Neurological and Urodynamic Urology of the British Association of Urologists in the UK. The questionnaire aimed to identify the number of procedures performed for mesh complications and whether they were reported to the Medicines and Healthcare products Regulatory Agency (MHRA) and the patterns of referral and treatment RESULTS: Referral to a colleague in the same hospital was common practice (69 %). Only 27 % of respondents stated that they reported all removals to the MHRA. The numbers of surgical procedures were low, with most respondents performing between one and three procedures each year and many not performing any surgery for a specific mesh complication in the previous year. CONCLUSIONS Removal of exposed, eroded and/or painful vaginally inserted mesh is performed by many different surgeons in a variety of hospital settings in the UK.
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Affiliation(s)
- Jonathan Duckett
- Department of Obstetrics and Gynaecology, Medway Maritime Hospital, Windmill Road, Gillingham, Kent, UK, ME7 5NY.
| | - Roland Morley
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| | - Ash Monga
- University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Tim Hillard
- Poole Hospital NHS Foundation Trust, Poole, Dorset, UK, BH15 2JB
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19
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Affiliation(s)
- Tim Hillard
- Department of Obstetrics & Gynaecology, Poole Hospital NHS Foundation Trust, UK
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20
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Kennedy E, Hillard T. British Menopause Society 22nd annual conference, Winchester 2012. Menopause Int 2012; 18:149-152. [PMID: 23239584 DOI: 10.1258/mi.2012.012042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Elizabeth Kennedy
- Tayside Sexual and Reproductive Health Services, Ninewells Hospital, Dundee, UK
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22
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Abstract
Osteoporosis affects one in three women. There has been some confusion among women and health professionals about the management of osteoporosis since the publication of the Women's Health Initiative and Million Women studies. This guidance regarding estrogen-based and non-estrogen-based treatments for osteoporosis responds to the controversies about the benefits and risks of individual agents. Treatment choice should be based on up-to-date evidence and targeted to individual women's needs.
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Neven P, Lunde T, Benedetti-Panici P, Tiitinen A, Marinescu B, de Villiers T, Hillard T, Cano A, Peer E, Quail D, Nickelsen T. A multicentre randomised trial to compare uterine safety of raloxifene with a continuous combined hormone replacement therapy containing oestradiol and norethisterone acetate. BJOG 2003; 110:157-167. [PMID: 12618160 DOI: 10.1046/j.1471-0528.2003.02252.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
OBJECTIVE To compare the uterine effects of 60 mg of raloxifene with a continuous combined hormone replacement therapy, a preparation of 2 mg 17beta-oestradiol (E(2)) and 1 mg norethisterone acetate for a duration of 12 months. DESIGN A randomised, double-blind trial. SETTING Multicentre: Europe, Israel, South Africa. POPULATION Asymptomatic postmenopausal women with risk factors for osteoporosis or cardiovascular disease who had an endometrial thickness of less than 5 mm. One thousand and eight women were randomised for the six month core; of these 420 were invited to continue into a six month extension period. METHODS Randomisation to either raloxifene or continuous combined hormone replacement therapy. Patients, recruiters and assessors were blinded to the treatment used. MAIN OUTCOME MEASURES The frequency of vaginal spotting/bleeding as recorded in a diary, endometrial thickness and uterine volume as measured by transvaginal ultrasonography at baseline and after 6 and 12 months. RESULTS After six months of therapy with raloxifene, the rate of women on raloxifene reporting vaginal bleeding and spotting (6.8%) was similar to the rate in the lead-in phase (8.3%) but increased from 7.0% to 55.1% in the continuous combined hormone replacement therapy group. Raloxifene treatment was not associated with a significant change from baseline to endpoint in mean endometrial thickness (P = 0.11), whereas continuous combined hormone replacement therapy treatment was associated with an increase in this value of mean (SD) of 1.2 (2.2) mm (P < 0.001). Compared with raloxifene, mean endometrial thickness for women on continuous combined hormone replacement therapy was significantly increased at endpoint [4.6 (2.1) mm vs 3.5 (1.7) mm; change from baseline P < 0.001]. In the raloxifene group, there was a trend towards a decrease from baseline in uterine volume [from 31.4 (20.3) to 30.3 (16.2) mm; P = 0.37]; in the continuous combined hormone replacement therapy group, there was a significant increase in uterine volume [from 31.3 (16.3) to 54.0 (36.1) mm; P < 0.001], and the difference in the effect of both compounds on change in uterine volume at endpoint reached statistical significance (P < 0.001). Statistically significant differences between the treatment groups were sustained for all parameters during the extension period. Early discontinuation rates, both overall and due to adverse events, were significantly lower (P < 0.001) in the raloxifene group after 6 and 12 months. CONCLUSION Compared with continuous combined hormone replacement therapy, 6 and 12 months of raloxifene treatment do not lead to vaginal bleeding/spotting, are not associated with increased endometrial thickness or uterine volume and result in a significantly lower rate of early treatment discontinuations in asymptomatic women receiving treatment to prevent long term postmenopausal health risks.
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Affiliation(s)
- Patrick Neven
- Department of Gynecological Oncoogy, UZ-Gathusberg, Herestraat, Louvain, Belgium
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24
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Affiliation(s)
- Tim Hillard
- Department of Obstetrics and Gynaecology, Poole General Hospital, Dorset, UK.
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25
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Hillard T. Evaluation and management of the hormone replacement therapy (HRT) candidate. Int J Fertil Womens Med 1997; 42 Suppl 2:347-64. [PMID: 9397383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
As knowledge about menopause and hormone replacement therapy (HRT) has increased, it has become evident that a considerably higher percentage of postmenopausal women than the 20% to 30% currently treated could receive HRT. It is equally clear, however, that HRT is not appropriate for every woman and that "one size fits all" management of menopausal women is not always suitable. This paper, therefore, reviews published prescribing and management guidelines for instituting and maintaining HRT and summarizes current information concerning factors to be considered before recommending HRT. When choosing candidates, special attention should be placed on individual patient factors. A thorough history is required to determine the presence of contraindications and the likelihood of potential benefits and risk factors. The hormone replacement regimen, hormone preparations, and dosage forms that best meet the specific needs of the individual woman should be offered. Before undertaking long-term therapy, the candidate should be informed of the established and likely benefits and the relative risks of hormone therapy, and that the magnitude of some risks has not yet been definitively determined. The final decision to use therapy should be made by the patient, guided by her physician, and based on her current symptoms and her relative likelihood of developing coronary artery disease, osteoporotic fractures, and cancer. The ancillary benefits, the common side effects of each regimen, the bleeding patterns to expect, and the type and frequency of clinical monitoring that will be necessary during therapy should also be considered.
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Affiliation(s)
- T Hillard
- Poole Hospital NHS Trust, Dorset, U.K
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