Millions of women around the world continue to suffer unnecessarily from the physical and psychological effects of the menopause because of "mistaken fears" about the risks and benefits of hormone replacement therapy.

A world leader in human fertility and women's health has warned that continued under-utilisation of menopausal hormone therapy (MHT) will result in growing numbers of women experiencing diminished quality of life because of cardiovascular and metabolic diseases, osteoporosis and premature cognitive decline.

Addressing a global conference on human fertility in the Philippines today, Professor Eileen Manalo said more women now have a life expectancy exceeding 80 years meaning many will spend over a third of their lives in a postmenopausal state driven by hormone deficiency.

"Up to 80 per cent of all women are affected by menopausal symptoms with a quarter describing them as severe," she said.

"Although the menopause is a natural transition, it has important physiological manifestations resulting from hormonal changes that have far reaching short and long-term consequences.

"There is robust evidence that MHT initiated before the age of 60, or within 10 years from when menstruation ceases, is a highly effective treatment for the symptoms of the menopause, that it prevents hip fractures and reduces cardiovascular disease mortality."

Professor Manalo said MHT had been "demonised" over two decades ago by a study of thousands of women taking the hormone therapy that reported it was associated with higher risks of breast cancer and stroke.

She said countless women abruptly stopped MHT and many health care providers became reluctant to prescribe the therapy.

Eileen Manalo is a Professor in the Department of Obstetrics and Gynaecology of the University of the Philippines College of Medicine. She is a former President of the Philippine Society for Reproductive Medicine and is currently Assistant Secretary General of the International Federation of Fertility Societies.

Speaking at the 2024 Congress of the Asia Pacific Initiative on Reproduction (ASPIRE) in Manila, Professor Manalo said the report published 22 years ago had devastating consequences.

She said a legacy of the report had been a fear of cancer among women that had overshadowed the potential benefits of MHT, which have been informed by more recent randomised control studies (RCTs) around the world.

"Cumulated RCT findings are consistent with the large body of observational studies that consistently show a reduction of all-cause mortality and cardiovascular disease in women who initiate hormone replacement therapy at the time of menopause," Professor Manalo explained.

"Additional MHT benefits include reduction in menopausal symptoms, potential reduction in cancer and other mortalities, prevention of new onset diabetes mellitus and osteoporosis with increased bone fracture prevention and improved quality of life.

"Evidence-based data from RCTs are reassuring that risks associated with MHT are rare – less than 10 cases per 10,000 women – when initiated at 60 years or less or within 10 years on menopause onset.

"The magnitude and types of MHT risks, including breast cancer, stroke and cardiovascular disease (CVD) are rare.

"They are not unique to MHT and are comparable with or less than other commonly used medications including those used for CVD prevention, such as statins, aspirin and other regular medications used for high blood pressure, for example ACE inhibitors.

"Meanwhile, an increase in stroke and cardiac deaths has been reported among women who discontinued their MHT compared to women who went on to use hormone therapy.

"The past 22 years since the report have brought a better understanding of the overall risks and benefits of MHT.

"It is time to heed the call of the International Federation of Gynaecology and Obstetrics for healthcare practitioners to protect the lives of mid-life women by increasing awareness of the symptoms of menopause, providing healthcare options including MHT, and promoting healthy lifestyle changes.

"The improvements we make during the menopausal transition and the early years of the menopause will help create the most significant impact on the quality of life of this ever-increasing population of women."

The ASPIRE Congress is being held at the Philippine International Convention Centre in Manila from today until Sunday (26 May). For further information, go to the Congress website www.aspire2024.com