2022 NAMS Position Statement on Hormone Therapy - What Every Woman Must Know Now!

Written and edited by Sarah Bonza MD. MPH, FAAFP, DipABLM, NBC-HWC

Let’s take a look at the 2022 North American Menopause Society Hormone Therapy Position Statement. This statement brought crucial updates to the 2017 edition and serves as a beacon for future research in the domain of women's health and menopause.

Formulated by an expert Advisory Panel comprising of clinicians and researchers, the new recommendations underscore the importance of evidence-based decision-making in hormone therapy.

Read more on my thoughts about hormone therapy for perimenopause and menopause relief here.

The key findings:

1. Hormone Therapy as an Effective Intervention

The Advisory Panel confirms that hormone therapy remains the most effective treatment for vasomotor symptoms (VMS) and the genitourinary syndrome of menopause (GSM). Furthermore, it's proven instrumental in preventing bone loss and fractures.

2. Individualized Treatment Plans

One of the main highlights from the position statement is the emphasis on individualized treatment. Hormone therapy isn't a one-size-fits-all solution. Risks differ based on various factors - type of therapy, dose, duration, administration route, initiation timing, and the use of a progestogen. For optimal results and minimal risks, treatment plans should be tailored to individual needs, supported by the best available evidence, and re-evaluated periodically.

3. Favorable Benefit-Risk Ratio

For women under 60 years or within 10 years of menopause onset without contraindications, hormone therapy offers a favorable benefit-risk ratio. This therapy can effectively manage bothersome VMS and prevent bone loss. Moreover, longer therapy durations seem to be more favorable for estrogen therapy (ET) than for estrogen-progestin therapy (EPT).

Menopausal woman taking hormone therao

4. Increased Risk for Late Initiators

The position statement notes a less favorable benefit-risk ratio for women who initiate hormone therapy more than 10 or 20 years from menopause onset or when aged 60 years or older. The reason? Greater absolute risks of coronary heart disease (CHD), stroke, venous thromboembolism (VTE), and dementia.

5. Managing GSM Symptoms

The statement also addresses the issue of GSM symptoms, which may not always find relief in non-hormonal therapies. For these cases, low-dose vaginal estrogen therapy (ET) or other approved therapies like vaginal dehydroepiandrosterone (DHEA) or oral ospemifene are recommended.

In conclusion, the 2022 NAMS Position Statement provides a comprehensive guide to navigating the nuances of hormone therapy for menopause. It underscores the need for personalized treatment plans, early initiation where possible, and careful consideration of the benefit-risk ratio based on individual circumstances. As we move forward, the focus remains on maximizing benefits and minimizing risks to help women lead healthy lives during and post-menopause.

References:

Faubion, Stephanie S. MD, MBA, FACP, NCMP; Crandall, Carolyn J. MD, MS, MACP, NCMP, FASBMR; Davis, Lori DNP, FNP-C, NCMP; El Khoudary, Samar R. PhD, MPH, FAHA; Hodis, Howard N. MD; Lobo, Roger A. MD; Maki, Pauline M. PhD; Manson, JoAnn E. MD, DrPH, MACP, NCMP; Pinkerton, JoAnn V. MD, FACOG, NCMP; Santoro, Nanette F. MD; Shifren, Jan L. MD, NCMP; Shufelt, Chrisandra L. MD, MS, FACP, NCMP; Thurston, Rebecca C. PhD, FABMR, FAPS; Wolfman, Wendy MD, FRCSC, FACOG. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause 29(7):p 767-794, July 2022. | DOI: 10.1097/GME.0000000000002028