The Global Consensus on Menopausal Hormone Therapy 2016
The Global Consensus on Menopausal Hormone Therapy is a consensus guideline by the collaboration of the International Menopause Society, The Endocrine Society, The North American Menopause Society, European Menopause and Andropause Society, The Asia Pacific Menopause Federation, The Federation of Latin American Menopause Societies and International Osteoporosis Foundation. The first consensus guideline came out in 2013 in order to help both health care providers and potential users of menopausal hormone therapy (MHT). This revised 2016 statement is based on the latest information and research into menopause and its treatment modalities.
The 12 key points are as follows:
1. MHT is the most effective treatment for vasomotor symptoms associated with menopause at any age, but benefits are more likely to outweigh risks for symptomatic women before the age of 60 years or within 10 years after menopause.
2. MHT is effective and appropriate for the prevention of osteoporosis-related fractures in at-risk women before age 60 years or within 10 years after menopause.
3. Standard-dose estrogen-alone MHT may decrease coronary heart disease and all-cause mortality in women younger than 60 years of age and within 10 years of menopause. Data on estrogen plus progestogen MHT in this population in most randomized clinical trials show no significant increase or decrease in coronary heart disease has been found.
4. Local low-dose estrogen therapy is preferred for women whose symptoms are limited to vaginal dryness or associated discomfort with intercourse.
5. Estrogen as a single systemic agent is appropriate in women after hysterectomy but additional progestogen is required in the presence of a uterus.
6. The option of MHT is an individual decision in terms of quality of life and health priorities as well as personal risk factors such as age, time since menopause and the risk of venous thromboembolism, stroke, ischemic heart disease and breast cancer.
7. The risk of venous thromboembolism and ischemic stroke increases with oral MHT but the absolute risk is rare below age 60 years. Observational studies point to a lower risk with transdermal therapy.
8. The risk of breast cancer in women over 50 years associated with MHT is a complex issue. The increased risk of breast cancer is primarily associated with the addition of a progestogen to estrogen therapy and related to the duration of use. The risk of breast cancer attributable to MHT is small and the risk decreases after treatment is stopped.
9. The dose and duration of MHT should be consistent with treatment goals and safety issues and should be individualized.
10. In women with premature ovarian insufficiency, systemic MHT is recommended at least until the average age of the natural menopause.
11. The use of custom-compounded bioidentical hormone therapy is not recommended.
12. Current safety data do not support the use of MHT in breast cancer survivors.
de Villiers TJ, Gass ML, Haines CJ, Hall JE, Lobo RA, Pierroz DD, Rees M. Global Consensus Statement on menop
The 2017 hormone therapy position statement of The North American Menopause Society
The 2017 Hormone Therapy Position Statement of The North American Menopause Society (NAMS) updates the 2012 Hormone Therapy Position Statement of The North American Menopause Society and identifies future research needs.
• The risks of HT differ for different women, depending on type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is needed. Treatment should be individualized using the best available evidence to maximize benefits and minimize risks, with periodic reevaluation for the benefits and risks of HT continuation.
• For women aged younger than 60 years or who are within 10 years of menopause onset and have no contraindications, the benefit-risk ratio appears favorable for treatment of bothersome hot flashes and for those at elevated risk of bone loss or fracture. Longer duration may be more favorable for estrogen-alone therapy than for estrogen-progestogen therapy, based on the Women’s Health Initiative randomized, controlled trials.
• For women who initiate HT more than 10 or 20 years from menopause onset or when aged 60 years or older, the benefit-risk ratio appears less favorable than for younger women because of greater absolute risks of coronary heart disease, stroke, venous thromboembolism, and dementia.
• 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 hot flashes, quality-of-life issues, or prevention of osteoporosis after appropriate evaluation and counseling of benefits and risks.
• Vaginal estrogen (and systemic if required) or other nonestrogen therapies may be used at any age for prevention or treatment of the genitourinary syndrome of menopause.