Hormone therapy remains the most effective treatment for vasomotor symptoms (VMS) and the genitourinary syndrome of menopause (GSM) and has been shown to prevent bone loss and fracture.
Personalization with shared decision-making remains key, with periodic reevaluation to determine an individual woman’s benefit-risk profile, with recommendations for the use of the appropriate dose, duration, regimen, and route of administration required to manage a woman’s symptoms and to meet treatment goals.
Risk stratification by age and time since menopause is recommended.
The benefits of hormone therapy outweigh the risks for most healthy symptomatic women who are aged younger than 60 years and within 10 years of menopause onset.
Transdermal routes of administration and lower doses of hormone therapy may decrease risk of venous thromboembolism and stroke.
Women with primary ovarian insufficiency and premature or early menopause have higher risks of bone loss, heart disease, and cognitive or affective disorders associated with estrogen deficiency. It is recommended that hormone therapy can be used until at least the mean age of menopause unless there is a contraindication to its use.
There is a paucity of randomized, controlled trial data about the risks of extended duration of hormone therapy in women aged older than 60 or 65 years, although observational studies suggest a potential rare risk of breast cancer with increased duration of hormone therapy.
For select survivors of breast and endometrial cancer, observational data show that use of low-dose vaginal estrogen therapy for those who fail nonhormone therapy for treatment of GSM appears safe and greatly improves quality of life for many.
Breast cancer risk does not increase appreciably with short-term use of estrogen-progestogen therapy and may be decreased with estrogen alone.
Compounded bioidentical HT presents safety concerns, such as minimal government regulation and monitoring, overdosing or underdosing, presence of impurities or lack of sterility, lack of scientific efficacy and safety data, and lack of a label outlining risks.
Hormone therapy does not need to be routinely discontinued in women aged older than 60 or 65 years and can be considered for continuation beyond age 65 for persistent VMS, quality-of-life issues, or prevention of osteoporosis after appropriate evaluation and counseling of benefits and risks.
For women with GSM, vaginal estrogen (and systemic if required) or other nonestrogen therapies may be used at any age and for extended duration, if needed.
The 2022 Hormone Therapy Position Statement of The North American Menopause Society has been endorsed by more than 20 well-respected international organizations.
The Position Statement is available on the NAMS website.
The patient-education piece, “Deciding About Hormone Therapy Use,” part of NAMS MenoNote series available on the website, has been updated by Jan L. Shifren, MD, NCMP, to coincide with the release of the Position Statement. This valuable handout simplifies the data in the new Position Statement for women trying to make decisions about using hormone therapy.
“NAMS is pleased to announce the release of its updated Position Statement on hormone therapy. Since our last Position Statement on hormone therapy published in 2017, there have been important additions that further clarify the balance of risks and benefits of hormone therapy options for menopause symptoms,” says Dr. Stephanie S. Faubion, NAMS Medical Director and lead of the Advisory Panel of “The 2022 Hormone Therapy Position Statement of The North American Menopause Society.” “NAMS has reviewed existing data on hormone therapies published after the last Position Statement, and after exhaustive research and review of the literature, we have found that what hasn’t changed is that hormone therapy remains the most effective treatment for vasomotor symptoms and the genitourinary syndrome of menopause and has been shown to prevent bone loss and fracture.”
The 2022 Hormone Therapy Position Statement of The North American Menopause Society Advisory Panel
Stephanie S Faubion, MD, MBA, FACP, NCMP, IF, Lead
Carolyn J Crandall, MD, MS, FACP, NCMP, FASBMR
Lori Davis, MSN, FNP-C, NCMP
Samar R El Khoudary, PhD, MPH, BPharm, FAHA
Howard N Hodis, MD
Roger A Lobo, MD
Pauline M Maki, PhD
JoAnn E Manson, MD, DrPH, NCMP
JoAnn V Pinkerton, MD, NCMP
Nanette F Santoro, MD
Jan L Shifren, MD, NCMP
Chrisandra L Shufelt, MD, MS, FACP, NCMP
Rebecca C Thurston, PhD
Wendy Wolfman, MD, FRCSC, FACOG
“The 2022 Hormone Therapy Position Statement of The North American Menopause Society” (NAMS) updates “The 2017 Hormone Therapy Position Statement of The North American Menopause Society” and identifies future research needs. An Advisory Panel of clinicians and researchers expert in the field of women’s health and menopause was recruited by NAMS to review the 2017 Position Statement, evaluate new literature, assess the evidence, and reach consensus on recommendations, using the level of evidence to identify the strength of recommendations and the quality of the evidence. The Advisory Panel’s recommendations were reviewed and approved by the NAMS Board of Trustees. Hormone therapy remains the most effective treatment for vasomotor symptoms (VMS) and the genitourinary syndrome of menopause and has been shown to prevent bone loss and fracture. The risks of hormone therapy differ depending on type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is used. Treatment should be individualized using the best available evidence to maximize benefits and minimize risks, with periodic reevaluation of the benefits and risks of continuing therapy.
For women aged younger than 60 years or who are within 10 years of menopause onset and have no contraindications, the benefit-risk ratio is favorable for treatment of bothersome VMS and prevention of bone loss. For women who initiate hormone therapy more than 10 years from menopause onset or who are aged older than 60 years, the benefit-risk ratio appears less favorable because of the greater absolute risks of coronary heart disease, stroke, venous thromboembolism, and dementia. Longer durations of therapy should be for documented indications such as persistent VMS, with shared decision-making and periodic reevaluation. For bothersome genitourinary syndrome of menopause symptoms not relieved with over-the-counter therapies in women without indications for use of systemic hormone therapy, low-dose vaginal estrogen therapy or other therapies (eg, vaginal dehydroepiandrosterone or oral ospemifene) are recommended.
Content created 9 July 2022