Deciding how one approaches menopause and dealing with the manifestations of hormone loss in daily life are quite challenging for women entering this time in their lives. Bombarded with advertisements from drug companies, nutrition supplement manufacturers, a multitude of publications and authors writing on the subject, one hardly knows what is best and safe. Many women are finding reliable solutions and directions in solid research based answers provided through the North American Menopause Society.
NAMS is recognized as the preeminent resource on menopause for both healthcare providers and the public. It is a leading non-profit organization whose sole mission is to promote health and quality of life for all women approaching and enduring this time in life. NAMS has been around since 1989 and has a large, strong worldwide membership in 50 countries. They are responsible for organizing major scientific meetings, reviewing and publishing key research data through monthly newsletters, a professional journal, and website position papers on hormone therapies. Their journal entitled Menopause is now ranked as the top OB/GYN professional resource. They have an impressive award winning website, notably absent of advertisements, that is visited by over 100,000 visitors per month. Every aspect of menopause is addressed in an easy to follow format for the professional as well as the general public. In 2007, they published their 3rd edition of Menopause Practice: A Clinician’s Guide, a best-selling industry reference source. Their Board of Trustees is represented by all key health disciplines. Society publications and position papers are developed and published through extensive consultation with an esteemed medical advisory panel.
Beginning in 2002, the Society began publishing their position statements on menopausal hormone therapy (HT). Their goal was to spread research findings on benefits and risks of various therapies including bio-identical hormones for menopause-related symptoms and disease prevention over the span of a woman’s life. This week NAMS released updated recommendations for the use of prescription hormone replacement therapy used in the USA and Canada. These recommendations continued to build on prior research findings published in 2002, 2004, 2007, and 2008 dealing with a host of topics: hot flashes, sleep deprivation, vaginal dryness and atrophy, sexual function, urinary tract infections, changes in body weight, osteoporosis, heart disease, stroke, venous thromboembolism, diabetes, cancer, and dementia.
According to NAMS, over the last two years, there has been accumulating scientific evidence that various estrogen and progesterone products, routes of administration, and timing of therapy confer differing benefit-risk profiles over a woman’s lifetime. Hormone therapy, appropriate and beneficial for early menopause, will not provide the same benefits as the woman ages. As diseases emerge with aging, using hormone therapy either as a new or long-term treatment may have a less acceptable benefit-risk ratio. Benefits and risks in post-menopausal women should be carefully reviewed by the practitioner and discussed with the patient. This also applies to a host of diseases where data is simply not available, inconclusive, or has shown risk under study.
The science over the last two years also is now very clear:
Hormone therapy is not recommended for women with histories of endometrial cancer.
In breast cancer survivors, estrogen only therapy has not been proven safe and might raise recurrence risk.
Intrauterine systems cannot be recommended for endometrial protection in estrogen-only therapy users.
When hormone therapy is discontinued after several years of use, bone-mineral density should be assessed, and medication to prevent fractures should be initiated, if appropriate.
Other NAMS recommendations come from research on heart disease. Prior data showed hormone therapy did not offer heart disease protection. However, when taken by younger women (age range, 50–59) or within 10 years after menopause, current data shows no increased risk for coronary heart disease (CHD). In fact, emerging evidence suggests that estrogen-only therapy begun early in menopause actually might lower CHD risk. There are many variables in this data, but the evidence is not showing heart health harm. The latest recommendations also reveal that “because incidence of disease outcomes increases with age and time since menopause, the benefit-risk ratio for HT is more likely to be acceptable for short-term use for symptom reduction in a younger population. In contrast, long-term HT or HT initiation in older women may have a less acceptable ratio.”
In final and noted by NAMS, recent studies generally show that hormone therapy is associated with low absolute risks — although anxiety about its use seems to remain high among women in general (as well as among many clinicians). This updated NAMS position might help clinicians provide individualized education and treatment for menopausal women.