New Menopause Hormone Therapy Position Statement released by NAMS
By: Holly L. Thacker, MD Posted on September 11, 2017
2017 NAMS Position Statement on Hormone Therapy
It has been five years since the North American Menopause Society (NAMS) released an updated position statement on the use of Hormone Therapy and 15 years since the release of the Women’s Health Initiative (WHI) initial study which shook the world of women’s health. This new statement incorporates special populations of interest and FINALLY debunks the inappropriate catch phrase of “lowest dose for the shortest amount of time.”
I wrote a column writing that the tone and theme of the 2012 NAMS position statement were finally “reassuring.” By October 2012, I pointedly wrote that “The anti-hormone party is over!” in that emerging data continued to show more benefit than risk and actual mortality reduction.
That is huge - not just symptom reduction but death rate reduction!
Top 9 Highlights from 2017 NAMS Statement
NAMS has finally clarified what many of us menopausal physician experts have been saying for years, to the more fitting concept of the “appropriate dose, duration, regimen, and route of administration” to “hormone therapy that provides the most benefit with the minimal amount of risk.” That concept can and should be applied to virtually any medical therapy.
- Early Menopause. Women with premature or early menopause should use hormone replacement therapy, barring active contraindication at least until the typical age of menopause age 52.
- Family history of breast cancer is NOT a contraindication to HT. For women who are BRCA-positive they are at higher genetic risk for ER negative breast cancer. For those who have undergone surgical menopause (bilateral removal of ovaries) the benefits of HT generally outweigh risk and need to be individualized.
- For select survivors of breast and endometrial cancer, vaginal estrogen appears safe. Use of systemic HT needs careful consideration for survivors of estrogen-sensitive cancer and should be used for compelling reasons in conjunction with the woman’s oncologist after failure of non-hormonal options.
- Economic considerations for not treating menopausal was emphasized with indirect costs. This includs effects on quality of life, work productivity, healthcare utilization particularly, in women who have had a hysterectomy who are not receiving estrogen.
- Hormone therapy does NOT need to be routinely discontinued simply because a woman turns 65.
- There appears to be no effect of HT on lung cancer incidence. But of course all smokers should be encouraged to attain smoking cessation.
- Women on HT appear to have less joint pain compared to women not on HT.
- Colon cancer incidence appears to be REDUCED with HT use.
- Hormone therapy significantly reduces the diagnosis of type 2 Diabetes Mellitus. HT may also help reduce abdominal fat and weight gain often associated with menopause transition.
Hormone Therapy is Safe to Use for Menopausal Symptoms
By 2013, the long term data on long term use of hormone therapy was clearly contradicting the dire and stingy previous recommendations of the lowest dose for the shortest amount of time. In fact, the invited article I wrote for an OB-GYN journal for physicians almost did not get published as apparently some of the WHI investigators were not pleased with my invited commentary and tried to block the publication.
For some time, I have been a vocal critic how a very scientific study, the Women’s Health Initiative (WHI) has been unscientifically interpreted and how millions of women have needlessly suffered by being fearful of the use of estrogen. Certainly, not all menopausal women have or need to use hormone therapy, but many do and many benefit, especially the following women:
- Women with symptoms
- Younger women
- Women who have been castrated
Do Not Fear Hormone Therapy
It is a shame that the fear of using hormone therapy has frightened so many women and so many physicians leading to needless suffering.
All choices and medical therapies have potential benefits and potential risks and being hormone deficient has certain risks such as:
- Sexual dysfunction
- Vulvovaginal atrophy
- Disruptive hot flashes that can lead to sleep disturbances.
I bristle at the term “position statement” as it implies a political position as if one is “for or against” something. Any hormone, be it sex hormones (like estrogen, progesterone, testosterone), thyroid hormone and insulin should be just the right amount for the individual person’s:
- stage in life
- medical history
- concerns of the individual person
Menopausal Resources Available to Women
I have written two books detailing the individual approach to perimenopause and menopause, Women’s Health: Your Body, Your Hormones, Your Choices and Cleveland Clinic Guide to Menopause.
Speakingofwomenshealth.com highlights new research, new hormone and non-hormone therapy options as well as provides a vast array of free resources and free treatment guidebooks with the goal to empower women to be strong, be healthy and be in charge!
The terrific news is that it is 2017 and not 1917 or 1817 when women had limited to no options to deal with menopause and the vicissitudes of aging. Women should be empowered by options, research and albeit a delayed, but updated position statement on the use of hormone therapy.
Be Strong. Be Healthy. Be in Charge!
-Holly L. Thacker MD FACP CCD NCMP Professor and Director of the Center for Specialized Women’s Health
Holly L. Thacker, MD, FACP is nationally known for her leadership in women’s health. She is the founder of the Cleveland Clinic Women’s Health Fellowship and is currently the Professor and Director of the Center for Specialized Women’s Health at Cleveland Clinic and Lerner College of Medicine at Case Western Reserve University. Dr. Thacker is also the Executive Director of Speaking of Women’s Health and the author of The Cleveland Clinic Guide to Menopause. Her special interests and areas of research including menopause and related medical problems including osteoporosis, hormone therapy, breast cancer risk assessment, menstrual disorders, female sexual dysfunction and interdisciplinary women’s health.