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North American Menopause Society Updates Position Statement on Hormone Therapy, Says Benefits Outweigh Risks for Some Women

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In its updated guidelines on using hormone replacement therapy (HRT), the North American Menopause Society says that HRT is an effective treatment for hot flashes and other menopausal symptoms. For women younger than 60 or within 10 years of menopause who have no other contraindications, the benefits of HRT outweigh the risks when treating menopausal symptoms, especially hot flashes, and for women who have a higher-than-average risk of bone loss or breaking a bone.

The updated position statement was published in the June 2017 issue of Menopause: The Journal of the North American Menopause Society. Read “The 2017 hormone therapy position statement of The North American Menopause Society.”

It’s extremely important to know that being diagnosed with breast cancer is a contraindication for HRT. Women who have a history of breast cancer should NOT take HRT.

"The use of hormone therapy continues to be one of the most controversial and debated topics," said JoAnn V. Pinkerton, North American Menopause Society executive director. "The goal of this updated version of the Society's position statement is to provide excellent, evidence-based, current clinical recommendations to menopause practitioners for the improvement of care for women depending on them to help relieve menopause symptoms."

The statement also reviews the effects of HRT on various health conditions, such as cardiovascular disease and breast cancer, at different stages of a woman's life.

HRT is approved by the U.S. Food and Drug Administration to:

  • treat hot flashes
  • prevent bone loss
  • treat vaginal dryness and vaginal atrophy
  • treat premature low estrogen levels

It’s also important to know that the guidelines stress that for appropriate women, HRT should be given in the lowest effective dose possible that meets treatment goals.

The statement aims to clear up confusion surrounding the use of HRT:

  • The risks of HRT are different for different women, depending on type, dose, duration of use, route of administration, timing of initiation, and whether progestogen is needed. Treatment should be individualized using the best available evidence to maximize benefits and minimize risks, with periodic reevaluation of the benefits and risks of continuing HRT.
  • For women younger than 60 or who are within 10 years of menopause and have no contraindications, the benefits outweigh the risks for treating bothersome hot flashes and for women with higher-than-average risk of bone loss or fracture. Based on results from the Women's Health Initiative study, women who need to take HRT for a longer period of time should take estrogen-only HRT rather than combination HRT, which contains both estrogen and progesterone.
  • For women who start HRT more than 10 or 20 years after menopause starts or when they’re age 60 or older, the risks of HRT are greater than the benefits because HRT is linked to a higher risk of heart disease, stroke, blood clots, and dementia.
  • Women older than 60 or 65 don’t automatically have to stop taking HRT and can consider continuing HRT beyond age 65 for persistent hot flashes, quality-of-life issues, or prevention of osteoporosis after appropriate evaluation and counseling of the benefits and risks of HRT.
  • Vaginal estrogen (and systemic if required) or other non-estrogen therapies may be used at any age for prevention or treatment of vaginal dryness and other vaginal symptoms.

"The [North American Menopause Society] discovered through its review of the literature that the previous position that hormone therapy should be prescribed only for the 'lowest dose for the shortest period of time' may be inadequate or even harmful for some women," said Pinkerton. "The [North American Menopause Society] has clarified this position to the more fitting concept of the 'appropriate dose, duration, regimen, and route of administration' that provides the most benefit with the minimal amount of risk. In addition, women older than 65 years old will be relieved to know that they don't have to stop using hormone therapy for their bothersome hot flashes just because of their age. The data simply do not support it, but individualized evaluation and discussion is recommended."

Menopausal side effects can dramatically reduce quality of life for some women. These women have to weigh the benefits of HRT against the risks. If you're having severe hot flashes or other menopausal side effects and are considering HRT, talk to your doctor about all of your options. Ask how you can minimize your breast cancer risk AND relieve your symptoms. Be sure to discuss the pros and cons of different types and doses of HRT.

If you’ve been diagnosed with breast cancer, you should NOT take any type of HRT.

If you do decide to take HRT, try to take the lowest dose possible that still meets your treatment goals. You may want to ask your doctor if estrogen-only HRT is a good option for you. You also may want to ask your doctor about vaginal or transdermal HRT.

Learn more about menopause and ways to manage side effects on the Managing Menopausal Symptoms pages.

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