NAMS highlights benefit-risk ratio of hormone therapy for menopause

The 2012 Hormone Therapy Position Statement of The North American Menopause Society (NAMS) updates the evidence-based position statement published by NAMS in 2010 regarding recommendations for hormone therapy (HT) for postmenopausal women.

The updated position statement further distinguishes the emerging differences in the therapeutic benefit-risk ratio between estrogen therapy (ET) and combined estrogen-progestogen therapy (EPT) at various ages and time intervals since menopause onset.

The statement was published in the March 2012 issue of Menopause: The Journal of The North American Menopause Society. Highlights of the specific recommendations include:

The most effective treatment for menopausal vasomotor symptoms and associated quality of life is ET or EPT. Among healthy women younger than 60 years or within 10 years of menopause, neither ET nor EPT use is associated with increased risk for cardiovascular disease. Although stroke risk may be increased, it is still a rare occurrence among women younger than 60 years. Compared with ET, EPT is associated with a higher risk for coronary artery disease, and potentially of ovarian cancer, than ET.

Recommended duration of therapy differs for EPT in women with a uterus and for ET in women who have had a hysterectomy. NAMS recommends EPT for relief of hot flashes in women with a uterus, so that the progestogen component will protect the uterine lining from the carcinogenic effects of estrogen alone.

Heightened risk for breast cancer associated with more than 3 to 5 years of EPT use limits the duration of safe EPT use. For ET, the benefit-risk profile is more favorable. Because risk for breast cancer does not appear to increase during an average of 7 years of ET use, there is more flexibility in duration of ET treatment.

The decision to use HT should still be individualized and patient-specific, based on the patient’s priorities regarding health and quality of life, as well as on specific risk factors for thrombosis, cardiovascular disease, stroke, and breast cancer.

Safety data are lacking to support HT use in breast cancer survivors. Women with premature or early menopause and no contraindications to HT may use HT until age 51 years, which is the average age of natural menopause, or longer if needed to control symptoms.

HT use is associated with a lower fracture risk, but a higher risk for ischemic stroke, venous thromboembolism, and ovarian cancer.