Statement of Agreement of Hormone Therapy Use, 2012
A joint statement on hormone therapy use prepared by the North American Menopause Society (NAMS), the American Society for Reproductive Medicine (ASRM) and The Endocrine Society was published in July 2012. The statement has been endorsed by 12 other leading organizations in women’s health. The major points of agreement were:
- Hormone therapy is an acceptable option for the relatively young (up to age 59 or within ten years of menopause) and healthy women who are troubled by moderate to severe menopausal symptoms. Decisions to be made on individual basis.
- If women are experiencing vaginal dryness or discomfort with intercourse, the preferred treatments are low dose vaginal estrogen.
- Women who still have a uterus need to take a progestogen (progesterone or synthetic) along with estrogen to prevent cancer of the uterus. Women who have had their uterus removed can take estrogen alone.
- Both estrogen therapy and estrogen plus progestogen therapy increase the risk of blood clots in the legs and lungs, similar to birth control pills, patches and rings. Although the risks of blood clots and stroke increase with either type of hormone therapy, the risk is rare in women ages 50 to 59.
- There is an increased risk in breast cancer seen with 5 or more years of continuous estrogen with progestogen therapy, possibly earlier. The risk decreases after hormone therapy is discontinued.
It has been recommended that women work with their health care providers to assess their personal risks and benefits. It is recommended that the lowest dose of estrogen that provides symptoms relief be used, and for the shortest duration needed.
The 2012 Hormone Therapy Position Statement of the North American Menopause Society
In addition to the above, NAMS published their most recent position Statement on Hormone Therapy in March, 2012. Their conclusions and recommendations:
- The decision to use HT should be made individually for each woman based on her health, her quality of life priorities and her personal risk factors for diseases.
- The duration of therapy is different for HT and ET. HT use should be limited to 3 to 5 years due to increasing risk of breast cancer with longer use. ET has been shown to have a favorable risk-benefit profile up to 7 years of use and 4 years follow-up.
- ET is the most effective treatment of symptoms of vulvar and vaginal atrophy. Low-dose, local vaginal ET is recommended when only vaginal symptoms are present.
- Women with premature or early menopause, who are otherwise appropriate candidates for HT can use HT at least until the median age of natural menopause (51 years). They may use HT longer if needed for symptom management.
- Although ET did not increase breast cancer risk in the WHI, there is a lack of safety data supporting the use of ET in breast cancer survivors; one RCT reported a higher increase in breast cancer recurrence rates.
- Both transdermal and low-dose oral estrogen have been associated with lower risks of VTE and stroke than standard doses of oral estrogen (RCT evidence not yet available at publication time).