NAMS Guidance on MHT

In June this year the North American Menopause Society (NAMS) issued a new Position Statement on the use of hormone therapy (HT) for menopausal and postmenopausal women. An expert Advisory Panel of clinicians and researchers were recruited by NAMS to review the existing 2012 Statement, evaluate new literature, and reach consensus on recommendations. These recommendations were then reviewed and approved by the NAMS Board of Trustees.

Speaking ahead of the release, Dr JoAnn V. Pinkerton, NAMS executive director, said "The goal of this updated version of the Society's position statement is to provide excellent, evidence-based, current clinical recommendations to menopause practitioners for the improvement of care for women depending on them to help relieve menopause symptoms."

Dr Pinkerton iterated that while “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,” it nonetheless “continues to be one of the most controversial and debated topics,”

So, what are the key recommendations that have changed since 2012? The statement aims to address the continuing confusion surrounding the use of HT:

·        The risks of HT differ between women, depending on treatment, dose, duration of use, route of administration, timing of initiation, and whether progestogen is needed. Treatment should be individualised to ensure maximum benefit and minimal risk.

·        For women aged younger than 60 years or who are within 10 years of menopause onset and have no contraindications, the benefit-risk ratio appears favourable for treatment of hot flashes and for those at elevated risk of bone loss or fracture.

·        HT does not need to be routinely discontinued in women aged older than 60 or 65 years and can be continued beyond age 65 years for persistent hot flashes, quality-of-life issues, or prevention of osteoporosis after appropriate evaluation and counselling of benefits and risks.

·        Low-dose vaginal oestrogen may alleviate urinary and vaginal symptoms, as well as sexual-function difficulties.

What about older women and extended treatment of HT?

·        The statement cautions that if initiated in women who are 10 more years out from their menopause or when they are 60 years of age or older, the benefit-risk ratio is less favourable because of greater absolute risks of coronary heart disease, stroke, venous thromboembolism, and dementia.

The full Position Statement can be found on the NAMS website here.