The 2017 Hormone Therapy Position Statement of The North American Menopause Society

The North American Menopause Society 2017 Hormone Therapy Position Statement Advisory Panel

Disclosures

The North American Menopause Society (NAMS). 2018;24(7):728-753. 

In This Article

Diabetes Mellitus, Metabolic Syndrome, and Body Composition

In the WHI, women receiving continuous-combined CEE + MPA had a statistically significant 19% reduction (HR, 0.81; 95% CI, 0.70–0.94; P = 0.005) in the incidence of type 2 diabetes mellitus (DM), translating to 16 fewer cases per 10,000 person-years of therapy.[14] In the CEE-alone cohort, there was a reduction of 14% in new diagnoses of type 2 DM (HR, 0.86; 95% CI, 0.76–0.98), translating to 21 fewer cases per 10,000 person-years. Meta-analyses of published studies found that combined HT (EPT) reduced type 2 DM incidence almost 40%, with lower fasting glucose levels and levels of hemoglobin A1c.[145,146] The benefit reverses when HT is discontinued.

Metabolic Syndrome and Weight

In general, ERα protects against fat accumulation, whereas ERβ promotes fat gain. There is evidence from basic and preclinical work that disruption of estradiol signaling, either with ER deletion (genetic manipulation) or surgical oophorectomy, may accelerate fat accumulation, which appears to accumulate disproportionately in the abdominal area, with increased insulin resistance and dyslipidemia.[137]

Estrogen-progestogen therapy either has no effect on weight or is associated with less weight gain in women who are using it than in women who are not.[147–151] In the WHI, women on combined CEE + MPA showed small but significant decreases in body mass index and waist circumference during the first year.[152]

Key Points

  • Hormone therapy significantly reduces the diagnosis of new-onset type 2 DM, but it is not US-government approved for this purpose.

  • Hormone therapy may help attenuate abdominal adipose accumulation and the weight gains that are often associated with the menopause transition.

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