NAMS report

OB/GYN News,  Oct 15, 2003  by Michele G. Sullivan

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The 2003 position statement of the North American Menopause Society contains recommendations for estrogen and progestogen use in peri- and postmenopausal women:

* An individual risk profile is essential for every woman contemplating hormone therapy. The absolute risks published thus far regarding hormone therapy are small, as are the benefits for bone and reduction in colon cancer risk. These risks are likely to be even smaller than published for women younger than age 50 years who are at low risk for coronary heart disease, stroke, osteoporosis, breast cancer, and colon cancer.

* Data from the Women's Health Initiative and the Heart and Estrogen/Progestin Replacement Study should be extrapolated with caution to women younger than 50 years who initiate hormone therapy and should not be extrapolated to women experiencing premature menopause (younger than 40 years) who initiate hormone therapy at that time.

* For the sake of consistency, hormone therapy is now the preferred term for regimens encompassing either estrogen therapy or estrogenprogestogen therapy. Progestogen is now the preferred term for both progesterone and progestin.

* Treatment of moderate and severe menopause symptoms remains the primary indication for systemic hormone therapy.

* No estrogen-progestogen regimen or estrogen-only regimen should be used for primary or secondary prevention of coronary heart disease or stroke.

* Because of the potential risks associated with hormone therapy, alternative therapies should be considered for women at high risk of postmenopausal osteoporosis.

* Initiating estrogen-progestogen therapy after age 65 years is not recommended for primary prevention of dementia since this therapy increases the risk of dementia during the ensuing 5 years in this population.

* Use of hormone therapy should be limited to the shortest duration consistent with treatment goals--although the panel did not come to consensus on the definition of either "short-term" or "long-term" hormone therapy.

* Lower-dose hormone therapy should be considered.

* Extended use of hormone therapy is acceptable for women who feel the benefits of symptom relief outweigh the risks, especially after a failed attempt to withdraw from hormone therapy; for women with moderate to severe symptoms who are at high risk for osteoporotic fracture; and for the prevention of osteoporosis in high-risk women when alternative therapies are not appropriate.

The full policy statement is available at www.menopause.org.

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