The North American Menopause Society (NAMS) has published a new position statement on the use of hormone therapy (HT) for menopausal and postmenopausal women, including a review of the impact of HT on conditions such as breast cancer and cardiovascular disease at different points of life. These updates were published in the journal Menopause.

The new position statement expands on five areas of confusion regarding HT:

Firstly, NAMS reiterates that HT should be individualized for each patient and requires periodic reevaluation for risks and benefits of selected therapy. The risk of HT varies depending on the type, dose, duration, route of administration, and timing of treatment initiation. Whether a progestogen is needed is also a factor in assessing risk.

Secondly, for women <60 years old or who are within 10 years of menopause onset and have no contraindications to HT, there is a favorable benefit-risk ratio for HT treatment of hot flashes and for those at elevated risk for bone loss or fracture. Longer duration of therapy may prove more favorable for estrogen monotherapy than for estrogen-progestogen therapy. 

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Conversely, for patients who initiate HT more than 10 or 20 years from menopause onset or who initiate when aged ≥60 years, the benefit-risk ratio is less favorable, considering greater absolute risks for coronary heart disease, stroke, venous thromboembolism and dementia in these patient populations.

In terms of continuation of therapy, HT does not need to be routinely discontinued in women >60 or 65 years old. HT may be continued in patients >65 years for persistent hot flashes, prevention of osteoporosis, and quality-of-life issues, with evaluation and counseling of risks and benefits.

Lastly, NAMS states that vaginal estrogen (and systemic, if required) or other non-estrogen therapies may be used for prevention or treatment of the genitourinary syndrome of menopause at any age.

“NAMS discovered through its review of the literature that the previous position that hormone therapy should be prescribed only for the ‘lowest dose for the shortest period of time’ may be inadequate or even harmful for some women,” stated Dr. JoAnn V. Pinkerton, executive director of NAMS. “NAMS has clarified this position to the more fitting concept of the ‘appropriate dose, duration, regimen, and route of administration’ that provides the most benefit with the minimal amount of risk.”

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