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

Early Natural Menopause and Primary Ovarian Insufficiency

Women with early natural menopause and POI experience an extended period of time with loss of ovarian hormone activity compared with women experiencing normal menopause, with potential AEs of estradiol deficiency in all tissues. For women whose ovaries are retained at the time of hysterectomy, there is a two-fold increased risk of ovarian failure,[91] and 20% or more of these women may develop symptoms of diminished ovarian reserve within 1 year, with reduced anti-mullerian hormone. Health risks of early natural menopause and POI may include persistent VMS, bone loss, VVA, mood changes, and increased risk of heart disease, dementia, stroke, Parkinson disease, ophthalmic disorders, and overall mortality.[26,28,93–95]

Women with POI have a higher risk of death from ischemic heart disease as well as from all causes compared with women who have a normal age of natural menopause,[27] which may be reflective of premature aging. They also have a higher risk of digestive tract cancer but a decreased risk of mortality from breast, uterine, and endometrial cancer.[94,96,97] Effective management may include appropriate doses of HT along with calcium, vitamin D, exercise, and screenings to detect medical issues. Although higher doses of HT appear to provide the best bone benefits,[29,98,99] oral contraceptives with an estrogen patch during the placebo week may be used if needed for psychological benefit in younger women.

Key Points

  • Women with early menopause and POI have health risks that may include persistent VMS, bone loss, VVA, mood changes, and increased risk of heart disease, dementia, stroke, Parkinson disease, ophthalmic disorders, and overall mortality.

  • Results of the WHI studies in older women do not apply to women with early menopause, and observational evidence suggests benefit with HT taken to the average age of menopause.

  • Hormone therapy such as transdermal estradiol in higher doses with adequate endometrial protection may be superior to oral contraceptive therapy to restore or maintain bone mineral density (BMD).

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