New statement on hormone therapy for women

The North American Menopause Society (NAMS) has updated its evidence-based position statement on hormone therapy. NAMS last published a position statement on hormone therapy in  2010. The new statement includes interim findings from observational studies and randomized controlled trials.

NAMS continues to emphasize that data support the initiation of HT around the time of menopause as an effective treatment for symptoms and fracture risk reduction, and that risks and benefits should be assessed for each woman.

Recognition is growing that the safety profile of systemic HT when used by younger menopausal women (i.e., women in their 50s or within 10 years of menopause onset) is reassuring.

The following points are new:

  1. Urinary tract health: Local (i.e., vaginal) estrogen therapy (ET) may benefit some women with overactive bladder.
  2. Osteoporosis: Low-dose HT effectively maintains or improves bone mineral density.
  3. Endometrial cancer: Progestogen alone “could be considered” for management of vasomotor symptoms, although no data are available.
  4. Cognitive decline: HT cannot be recommended at any age for preventing or treating cognitive decline and dementia.
  5. Premature menopause and primary ovarian failure: Women who experience early menopause (i.e., before age 40) and require bone-loss prevention are “probably best served” by administration of HT or oral contraceptives until they reach natural menopausal age (median, 51), at which time treatment can be reevaluated.
  6. Dosage and route of administration:
  • All ET administration routes (oral, transdermal, vaginal, and intrauterine) effectively diminish postmenopausal symptoms.
  • Accumulating evidence from observational trials suggests that, compared with standard-dose oral ET, transdermal ET may be associated with lower risk for venous thromboembolism, stroke, and myocardial infarction.
  • Both oral and transdermal combined estrogen-progestogen therapy (EPT) confer protection against endometrial cancer.
  1. Duration of use: Length of EPT use is limited by increased breast cancer risk associated with 3 to 5 years of use; the more favorable risk–benefit profile of ET (seen during a mean of 7 years of use plus 4 years of follow-up) allows longer-term use.
  2. Bioidentical hormones: Compounded EPT or ET should not be prescribed unless women are allergic to components of government-approved products.
  3. HT discontinuation: Vasomotor symptoms have a 50% chance of recurring when HT is discontinued, regardless of age, duration of use, or whether cessation is abrupt or gradual.

Published in Journal Watch Women’s Health March 29, 2012

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