In 2002, the highly publicized Women’s Health Initiative (WHI) established that risks outweighed benefits with regard to hormone therapy for the prevention of chronic disease. Thus began 10 years of debate regarding hormone therapy use. Now 15 top medical organizations have joined together to issue a statement of agreement pertaining to the benefits of hormone therapy for symptomatic menopausal women. The new joint statement, prepared by The North American Menopause Society (NAMS), the American Society for Reproductive Medicine (ASRM), and The Endocrine Society, has also been endorsed by 12 other leading organizations in women’s health.
In an effort to reassure women and their providers that hormone therapy is acceptable and relatively safe, the statement concludes that hormone therapy is still an appropriate treatment for menopausal symptoms in healthy, symptomatic, recently postmenopausal women.
“We want to emphasize the difference between taking hormone therapy short-term for treatment of menopausal symptoms versus taking hormone therapy for prevention of chronic diseases. Many women can safely take hormone therapy for relief of menopausal symptoms when they work closely with their provider to assess their personal risks and benefits,” said Dr Margery Gass, Executive Director of NAMS.
Roger Lobo, MD, past president of ASRM, added, “A decade of research and analysis has shown us that the generalized conclusions of the WHI do not apply to younger women at the beginning of the menopausal transition.”
To assist women and their physicians when deciding upon hormone therapy, the statement presents evidence-based key concepts regarding hormone therapy. Major points of agreement among the societies include:
- Hormone therapy is an acceptable option for the relatively young (up to age 59 or within 10 years of menopause) and healthy women who are bothered by moderate to severe menopausal symptoms. Individualization is key in the decision to use hormone therapy
- If women have only vaginal dryness or discomfort with intercourse, the preferred treatments are low doses of vaginal estrogen
- Women who still have a uterus need to take a progestogen (progesterone or a similar product) along with the estrogen to prevent cancer of the uterus. Women who have had their uterus removed can take estrogen alone
- Both estrogen therapy and estrogen with progestogen therapy increase the risk of blood clots in the legs and lungs, similar to birth control pills, patches, and rings. Although the risks of blood clots and stroke increase with either type of hormone therapy, the risk is rare in women ages 50-59
- An increased risk in breast cancer is seen with 5 or more years of continuous estrogen with progestogen therapy, possibly earlier. The risk decreases after hormone therapy is stopped.
The statement is being published in the journals of The North American Menopause Society, the American Society for Reproductive Medicine, and The Endocrine Society. It has been endorsed by the Academy of Women’s Health, the American Academy of Family Physicians, the American Academy of Physician Assistants, the American Association of Clinical Endocrinologists, the American Medical Women’s Association, the Asociación Mexicana para el Estudio del Climaterio, the Association of Reproductive Health Professionals, the National Association of Nurse Practitioners in Women’s Health, the National Osteoporosis Foundation, the Society for the Study of Reproduction, the Society of Obstetricians & Gynaecologists of Canada, and the SIGMA Canadian Menopause Society.