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Estrogen and progestogen use in postmenopausal women: 2010 position statement of The North American Menopause Society

doi: 10.1097/gme.0b013e3181d0f6b9
Position Statement

Objective: To update for both clinicians and the lay public the evidence-based position statement published by The North American Menopause Society (NAMS) in July 2008 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.

Methods: An Advisory Panel of clinicians and researchers expert in the field of women's health was enlisted to review the July 2008 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. Also participating in the review process were other interested organizations who then endorsed the document.

Results: 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. Areas that vary from the 2008 position statement are noted. A suggested reading list of key references published since the last statement is also provided.

Conclusions: 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 for women who initiate HT close to menopause but decreases in older women and with time since menopause in previously untreated women.

The North American Menopause Society has made significant additions and modifications to its recommendations on this important topic. This update incorporates current evidence into practical clinical recommendations, with consideration for the therapeutic benefit-risk ratio at various times through menopause and beyond.

This NAMS position statement has been endorsed by: 1HealthyWomen (formerly the National Women's Health Resource Center), 2Asociación Mexicana para el Estudio del Climaterio (AMEC), 3Society of Obstetricians and Gynaecologists of Canada (SOGC) 4The Endocrine Society, 5American Medical Women's Association (AMWA), and 6National Association of Nurse Practitioners in Women's Health (NPWH).

Received December 17, 2009; revised and accepted December 21, 2009.

The Board of Trustees of The North American Menopause Society (NAMS) developed this position statement with assistance from the following Advisory Panel: Wulf H. Utian, MD, PhD, DSc(Med), NCMP (Chair); Gloria A. Bachmann, MD; Elizabeth Battaglino Cahill;1 J. Christopher Gallagher, MD; Francine Grodstein, ScD; Julia R. Heiman, PhD, ABPP; Victor W. Henderson, MD, MS, NCMP; Howard N. Hodis, MD; Richard H. Karas, MD, PhD; JoAnn E. Manson, MD, DrPH; Julio H. Morfín-Martín, MD;2 Robert L. Reid, MD;3 Richard J. Santen, MD;4 Peter J. Schmidt, MD; Cynthia A. Stuenkel, MD, NCMP; Norma Jo Waxman, MD;5 and Susan Wysocki, WHNP-BC, FAANP.6 Approved by the NAMS Board of Trustees on December 16, 2009.

Address correspondence to: NAMS, 5900 Landerbrook Dr., Suite 390, Mayfield Heights, OH 44124, USA. E-mail: info@menopause.org.

Web Site: www.menopause.org

©2010The North American Menopause Society