NAMS Hormone Therapy Position Statement 2012
‘These days HT is really focused on treating menopausal symptoms versus the previous thought that women should be taking hormones for the rest of their lives,’ explains Dr. Margery Gass, Executive Director at NAMS. ‘We know that taking older women taking HT for longer periods of time will indeed face increased risks for health issues such as breast cancer and stroke. Hormones are safe and effective for most healthy women in the short term treatment for bothersome menopause symptoms.’
Among the recent findings, three important criteria emerge as the most important things to consider when deciding to take HT: dosage, duration, and delivery. The sooner a woman starts to take HT in menopause, at the lowest appropriate dosage, and for the shortest amount of time, the less likely the adverse effects on her health. This compares to older women over age 60 who take HT for longer periods of time and begin their therapy much later after menopause begins.
This means taking the least risky route when prescribing HT. More importantly, the risks and benefits vary between women, and an individual profile must address whether a woman is a suitable candidate for HT.
Prescribing the lowest dosage of estrogen to deal with menopausal symptom treatment goals, along with understanding the health risks and benefits, is the key to successful menopause management. Additionally, for those women who still have a uterus, a suitable amount of progestogen is added to the prescription to help reduce the risk of endometrial cancer.
The latest research shows that neither estrogen nor estrogen/progestogen therapies increase the risk of heart disease in healthy women under 60, or within 10 years of menopause. A minimal increased risk of stroke is possible but still very rare for women in their 50s.
How long women take HT does have an impact on the increased risk of developing breast cancer. But it also depends on what types of hormones are taken.
Women who still have their uterus may take a combination of estrogen and progestogen for a period of three to five years; taking this form of HT for longer periods does increase breast cancer risks.
Compare this to taking estrogen alone, prescribed for women who have had a hysterectomy, which is safe to use for up to seven years before any apparent risks of breast cancer. This makes estrogen a flexible option in terms of how long it may be taken to help treat menopausal symptoms.
Women have greater options when it comes to taking HT. Besides the traditional oral pills, there are creams, gels, patches, and sprays that are applied to the skin. Or women can choose to insert a cream, suppository, tablet, or ring into the genital area. This gives women increased flexibility when deciding which form of HT is best for them, and empowers women to work with their healthcare providers to make informed menopause treatment decisions.
For women dealing with premature or early menopause in their 30s or 40s, HT is still a safe treatment option and may be taken until the average age of menopause, around 51. Prolonged treatment may be suitable for some women; these decisions need to be made on an individual basis.
That is still the key to successful menopause management. No two women will go through menopause in the same way and their menopause treatments should also be individualized. In addition to severity and frequency of bothersome menopause symptoms, a woman’s personal health history including risk factors for heart disease, stroke, blood clots, and breast cancer need to be considered.
Not every woman will need or want to take hormones to deal with menopause. But after years of fear and confusion, HT remains a viable option that women may consider for menopause management.
A user friendly, easy to read version of the NAMS 2012 Hormone Therapy Position Statement may be found at: https://www.menopause.org/psht12patient.pdf This may be downloaded for reading and brought to your next doctor’s visit.
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