This Just In... from the North American Menopause Society (NAMS)
The 2022 Position Statement on Hormone Therapy
Last month in Athletic Aging we reviewed the British Menopause Society and the Royal College of Obstetricians and Gynecologists joint position statement on the appropriate use of hormone therapy in the post Best Practices for Menopausal Care - Is There Any Consensus? This month - hot off the press - The North American Menopause Society (NAMS) issued an update to the 2017 position statement on the use of hormone therapy in a new and improved 2022 position statement. The highlights from the 2022 version issued directly from NAMS are below.
In My Humble Opinion….
Having reviewed both the 2017 and 2022 statements, there appears to be a refreshing shift in multiple key elements of critical importance to mid-life women:
A considerable openness to the extended duration of HT without any clear time limits with the determining factor lying centrally with the risk/benefit equation individualized for each woman and the effective doses needed to relieve her symptoms.
Transdermal (via the skin) and lower doses of HT may decrease the risk of venous blood clots and stroke.
Statements on breast cancer risk emphasize that this is rare and that select breast cancer survivors may be candidates (in consultation with a woman’s oncologist) for low-dose HT.
Reaffirmation of the following:
The risk/benefit ratio for using HT is most favorable when initiated in women under the age of 65 within 10 years of the onset of menopause.
HT is recommended in women with premature ovarian insufficiency until at least the mean age of menopause onset.
HT remains the most effective treatment for hot flashes, genitourinary syndrome of menopause, and prevention of bone loss and fracture.
For the official, complete highlights issued by NAMS, please see below.
Highlights From The 2022 Hormone Therapy Position Statement of The North American Menopause Society
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 blood clots in the deep veins 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 non-estrogen therapies may be used at any age and for an 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.