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Leading menopause group calls for supporting hormone therapy for women over age 65

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The North American Menopause Society has formally recommended that hormone therapy be considered for women over age 65 years, citing recent research on longer-lasting menopausal symptoms and a lack of effective treatment alternatives.

HT, including oral and transdermal estrogens, remains on the list of potentially inappropriate medications (PIMs) for women over the age of 65 years, more commonly known as the Beers list. In a statement announcing its position, the North American Menopause Society (NAMS) noted that HT should instead be designated as a treatment to “use with caution,” a new category added to the list in 2012.

“The official position of NAMS is that there shouldn’t be hard and fast rules against hormones after age 65,” Wulf Utian, MD, medical director for NAMS, said in a press release. “Yes, there may be safety concerns, and the Society does recommend that a woman use the lowest dose of hormones for the time appropriate to meet her needs. But we know that, under some circumstances, hormone therapy can be appropriate for women over age 65 years, such as those instances when the benefits of treating hot flashes outweigh the risks or when a woman has a high risk of bone fractures and can’t take other bone drugs or can’t withstand their side effects.”

Utian said there is a “disconnect” between guideline recommendations and real-world clinical practice. He highlighted a July 2015 study in Menopause analyzing data from 2,000 Australian women, one of several to detail the severity of hot flashes as a bothersome symptom for postmenopausal women of all ages.

The low utilization of effective non-hormonal therapies for hot flashes demonstrates that menopause remains largely undertreated, Utian said.

“The use of hormone therapy should be individualized and not discontinued solely based on a woman’s age,” Utian in a statement. “NAMS encourages all women bothered by their menopause symptoms to seek the help they need and consider all of their options with the guidance of their clinician.”