The North American Menopause Society (NAMS) has updated its 2008 recommendations (JW Womens Health Jul 31 2008) for use of postmenopausal (HT) based on new evidence and collaboration with other professional societies. As before, the statement addresses only prescription HT products available in the U.S. and Canada. The guidelines newly acknowledge accumulating evidence that various estrogen and progestogen products, routes of administration, and timing of therapy confer differing benefit-risk profiles.
Additions to previous recommendations include the following:
- HT is not recommended for women with histories of
- In breast cancer survivors, estrogen therapy (ET) has not been proven safe and might raise recurrence risk.
- Intrauterine systems cannot be recommended for endometrial protection in ET users.
- When HT is discontinued after several years of use, bone-mineral density should be assessed, and medication to prevent fractures should be initiated, if appropriate.
NAMS reiterates that, although HT is not recommended for, its initiation by younger women (age range, 50–59) or within 10 years after menopause does not seem to raise risk for (CHD); emerging evidence suggests that ET initiation early in menopause might lower CHD risk. The guidelines state 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.”
Comment: As noted in the 2010 NAMS statement, published studies generally show that HT is associated with low absolute risks (JW Womens Health Apr 8 2010) — 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.
Published in Journal Watch Women’s Health April 15, 2010
North American Menopause Society. Estrogen and progestogen use in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause 2010 Mar/Apr; 17:242.
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DR. CHEW BOON HOW
MD (USM) Mmed Family Medicine (UM)
Senior Medical Lecturer, Family Medicine Specialist
Department of Family Medicine
Faculty of Medicine and Health Sciences
University Putra Malaysia, 43400 UPM Serdang,
Selangor Darul Ehsan, Malaysia