North American Menopause Society Updates Hormone Therapy Guidance

The North American Menopause Society (NAMS) has announced the release of a new position statement outlining the organization’s stance on hormone therapy.

Published on July 7, the statement was published with the intent of providing clinicians and patients with an update to the organization’s 2017 position statement on the same topic and has been endorsed by more than 20 international organizations, including the American Association of Clinical Endocrinology and the American Medical Women’s Association.

"NAMS is pleased to announce the release of its updated Position Statement on hormone therapy," says Stephanie S. Faubion, MD, NAMS Medical Director and lead of the Position Statement Advisory Panel, in a statement from NAMS. "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. 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 28-page document, which cites more than 340 references, was composed by Faubion, along with an advisory panel of 13 additional experts and was approved by the NAMS board of trustees. Using data from the review used to formulate the 2017 position statement and a more recent assessment of evidence, the position statement emphasizes the role of hormone therapy as the most effective treatment for vasomotor symptoms (VMS) and genitourinary syndrome of menopause (GSM). In the aforementioned release, NAMS provided selected highlights from the new position statement.

Highlights from 2022 Hormone Therapy Position Statement of NAMS:

• 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.
• NAMS recommends risk stratification by age and time since menopause.
• Benefits of hormone therapy outweigh the risks for most healthy symptomatic women 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 VTE and stroke.
• Women with primary ovarian insufficiency and premature or early menopause are at a greater risk of bone loss, heart disease, and cognitive or affective disorders associated with estrogen deficiency. NAMS recommends hormone therapy can be used until at least the mean age of menopause unless there is a contraindication to use.
• A paucity of RCT data exists related to the risks of extended duration of hormone therapy in women aged older than 60 or 65 years, but 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 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 hormone therapy presents safety concerns, including minimal government regulation, misadministration, 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.

This statement, “The 2022 hormone therapy position statement of The North American Menopause Society,” was published in Menopause.