NAMS Position Statement on Estrogen and Progestogen in Postmenopausal Women

June 25, 2009



To update for both clinicians and the lay public the evidence-based position statement published by The North American Menopause Society (NAMS) in March 2007 regarding its recommendations for menopausal hormone therapy (HT) for postmenopausal women, with consideration for the therapeutic benefit-risk ratio at various times through menopause and beyond.


An Advisory Panel of clinicians and researchers expert in the field of women's health was enlisted to review the March 2007 NAMS position statement, evaluate new evidence through an evidence-based analysis, and reach consensus on recommendations. The Panel's recommendations were reviewed and approved by the NAMS Board of Trustees as an official NAMS position statement. The document was provided to other interested organizations to seek their endorsement.


Current evidence supports a consensus regarding the role of HT in postmenopausal women, when potential therapeutic benefits and risks around the time of menopause are considered. This paper lists all these areas along with explanatory comments. Conclusions that vary from the 2007 position statement are highlighted. Addenda include a discussion of risk concepts, a new component not included in the 2007 paper, and a recommended list of areas for future HT research. A suggested reading list of key references is also provided.


Recent data support the initiation of HT around the time of menopause to treat menopause-related symptoms; to treat or reduce the risk of certain disorders, such as osteoporosis or fractures in select postmenopausal women; or both. The benefit-risk ratio for menopausal HT is favorable close to menopause but decreases with aging and with time since menopause in previously untreated women.

Key Words

Menopause • Perimenopause • Estrogen • Progestogen • Hormone therapy • Hormone replacement therapy • Vasomotor symptoms • Vaginal atrophy • Sexual function • Urinary health •Quality of life • Osteoporosis • Coronary heart disease • Venous thromboembolismStroke • Total mortality • Diabetes mellitus • Endometrial cancerBreast cancer • Mood • Depression • Dementia • Cognitive decline • Premature menopause • Premature ovarian failure • Bioidentical hormones • Postmenopause • Women's Health Initiative • NAMS.

The North American Menopause Society. Estrogen and progestogen use in postmenopausal women: July 2008 position statement of The North American Menopause Society. Menopause 2008;15:584-603.

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