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NAMS position statement on HT and menopause updated
The North American Menopause Society addresses the risk-benefit analysis and therapeutic issues of menopausal hormone therapy.
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The North American Menopause Society has issued an update to its 2007 recommendations on the use of menopausal hormone therapy in postmenopausal women.
The position statement was created by an advisory panel of women’s health experts in the research and clinical arenas. The panel reached a consensus on the recommendations after reviewing the 2007 statement and conducting an evidence-based analysis of new evidence. Using Medline, the panel identified literature dealing with menopause, postmenopause, estrogen and hormone therapy, published after the 2007 position statement.
“What we are presenting is a summary of the state of the science and art that can be best put together at this point in time; it is not meant as a set of rules to be followed,” Wulf H. Utian, MD, PhD, DSc, executive director of NAMS, told Endocrine Today.
Hormone therapy risks and benefits
In the position statement, the society highlights the changing nature of an individual woman’s risk-benefit ratio. The society also reminds clinicians that risk factors are linked to a woman’s baseline disease risks such as age, cause of menopause, time since menopause, prior use of hormones, types of hormones, routes of administration and doses of HT, as well as any medical conditions that emerged during treatment.
“We are addressing an important aspect of women’s health care in both the quality of life and preventive sides. This is an important area of women’s health and one where appropriate management can make a significant difference,” Utian said.
Updated risk-benefit information is described for the following outcomes:
- vaginal symptoms;
- sexual function;
- urinary health;
- change in body weight or BMI;
- cardiovascular effects like coronary heart disease, stroke and venous thromboembolism;
- endometrial cancer;
- breast cancer;
- mood and depression;
- cognitive aging/decline and dementia; and
- total mortality.
Therapeutic concerns
The position statement also includes new and updated information on the risks and benefits of therapeutic issues like dosing. The panel suggests a therapeutic goal that incorporates the lowest effective estrogen dose consistent with treatment goals, benefits and risks for each individual woman.
New information on the route of administration is also included, though the panel addresses the lack of known superiority between routes. Similarly, they recognize an inadequate amount of research to support a specific dosing regimen for endometrial safety when adding progestogen to estrogen.
“No one study can ever cover all eventualities and all populations under all circumstances. So, while you have to take all of the evidence into account, you also have to take the practicalities and the clinical perspective into account. Finally, you have to take into account the attitudes and requirements of the populations you are intending to address this information to,” Utian said.
Updated information and recommendations for “bioidentical” hormones along with other HT treatment issues such as timing of initiation of HT, duration of use, discontinuance and individualization of therapy are also available in the position statement.
“We hope those women who are generally well but highly symptomatic and very apprehensive can understand that there are therapies that are quite safe and effective and can enhance their quality of life,” Utian said. – by Stacey L. Adams
Menopause. 2008;15:584-603.