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

No General Rule for Stopping At Age 65

Initiation by postmenopausal women aged older than 60 years or who are more than 10 years from menopause onset has complex risks and requires careful consideration, recognizing that there may be well-counseled women aged older than 60 years who choose to initiate or restart HT. There are only limited nonblinded RCT data that address extended use of ET in younger, recently postmenopausal and perimeno-pausal women with or without added progestogen.[182] The WHI, the longest adequately powered blinded RCT, was limited to 5 to 7 years of therapy. However, the Beers criteria recommendation to routinely discontinue systemic HT in women aged 65 years and older is not supported by data.

Vasomotor symptoms persist on average 7.4 years and for many for more than 10 years.[43,267] In a study of Swedish women aged older than 85 years, 16% reported hot flashes at least several times per week.[268] Hormone therapy can be considered for prevention of osteoporosis in women aged 65 years and older at elevated risk for fracture when bothersome VMS persist or when HT remains the best choice for QOL reasons or because of lack of efficacy or intolerance of other osteoporosis-prevention therapies. Lower doses of transdermal estrogen may represent a preferable route of ET administration for older or menopausal women who are obese or for those with elevated triglycerides or liver concerns.[269] Ongoing monitoring for new health concerns, periodic trials of lower doses, transdermal formulations, or attempts at discontinuation may help healthcare providers and individual women aged older than 65 years clarify their decisions about continuing HT.

Key Points

  • Considerations for long-term (or extended) use of HT include persistent VMS, QOL issues, or prevention of osteoporosis in women at elevated risk of fracture.

  • The safety profile of HT is most favorable when it is initiated by women aged younger than 60 years or within 10 years of menopause onset. In general, initiation by older menopausal women aged older than 65 years requires careful consideration of all individual health benefits and risks.

  • Ongoing use of systemic HT by healthy women who initiated therapy within 10 years of menopause onset and without new health risks likely has a safety profile more favorable than that for women initiating HT when aged older than 65 years, although limited long-duration data are available.

  • Hormone therapy does not need to be routinely discontinued in women aged older than 60 or 65 years and can be considered for continuation beyond age 65 years for persistent VMS, QOL issues, or prevention of osteoporosis after appropriate evaluation and counseling of benefits and risks. Annual reevaluation, including reviewing comorbidities and periodic trials of lowering or discontinuing HT or changing to potentially safer low-dose transdermal routes, should be considered

  • Vaginal estrogen (and systemic if required) or other non-estrogen therapies may be used at any age for prevention or treatment of GSM.

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