Menopause Part 14: North American and European Guidelines for Hormonal Management of Menopause

Key points from the 2017 North American Menopause Society (NAMS) Hormone Therapy Position Statement include:[1]

 The European Menopause and Andropause Society (EMAS) position statement on management of menopause includes:[2]

•  Hormone therapy was most effective for vasomotor symptoms, genitourinary syndrome, prevention of bone loss, and reduction of bone fracture.
• Ideal benefit to risk ratio for use of hormone therapy is in symptomatic women with no contraindications, who are under 60 or within 10 years of menopause.
• Benefit to risk ratio was less favorable for women 60 or older, or more than 10 years out from menopause due to increased risk of coronary artery disease, dementia, stroke, and venous thromboembolism.
• Dose, duration, route, and initiation of hormone therapy will determine absolute risk from treatment.
• Therapy with estrogen alone may be more favorable than estrogen-progesterone therapy for prolonged treatment according to data from the Women’s Health Initiative trials.
• Bioidentical, compounded hormone therapy may be minimally regulated.

• Estrogen is given alone if post-hysterectomy.
• Use of transdermal estrogen reduces risk of thromboembolism.
• Progestogens are added to reduce the risk of endometrial cancer in women who have not had a hysterectomy.
• Use of progesterone or dydrogesterone instead of synthetic progestogens may reduce risk of venous thrombosis and breast cancer.
• Synthetic steroids, antidepressants, hypotensives, anti-depressants, and selective estrogen modulators may be used as well.  
• Androgen therapy is controversial as MHT.
• HRT should be reviewed within 3 months and then annually.
• Average weight gain of 22 pounds/10 kg) from 40-60 years of age can be countered with regular exercise and a healthy diet abundant in fruits and vegetables.