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October 13, 2021

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

Welcome to part 14 of the ODX Menopause Series. Here we review the North American Menopause Society and the European Menopause and Andropause Society position statement summaries on the management of menopause.

The ODX Menopause Series

  1. Menopause Part 1: A Quick Overview of a Slow Process
  2. Menopause Part 2: Biology and Physiology of Menopause
  3. Menopause Part 3: Increased Risk of Disease Associated with Menopause
  4. Menopause Part 4: Identifying Menopause: Signs and Symptoms
  5. Menopause Part 5: Laboratory Evaluation of Menopause
  6. Menopause Part 6: Cardiovascular Risk in Menopause
  7. Menopause Part 7: Beyond Hormone Testing in Menopause
  8. Menopause Part 8: Natural Approaches to Menopause
  9. Menopause Part 9: Diet and Nutrition Intervention in Menopause
  10. Menopause Part 10: Characteristic of Herbal Derivatives used to Alleviate Menopause Symptoms
  11. Menopause Part 11: Lifestyle Approaches to Menopause
  12. Menopause Part 12: The National Institute on Aging Addresses Hot Flashes
  13. Menopause Part 13: Hormone Replacement Therapy (HRT) in Menopause
  14. Menopause Part 14: North American and European Guidelines for Hormonal Management of Menopause
  15. Menopause Part 15: Bioidentical Hormone Therapy
  16. Menopause Part 16: Optimal Takeaways for Menopause
  17. Optimal The Podcast - Episode 10

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.

References

[1] Pinkerton, Joann V. “Hormone Therapy: Key Points From NAMS 2017 Position Statement.” Clinical obstetrics and gynecology vol. 61,3 (2018): 447-453. doi:10.1097/GRF.0000000000000383   

[2] Neves-E-Castro, Manuel et al. “EMAS position statement: The ten point guide to the integral management of menopausal health.” Maturitas vol. 81,1 (2015): 88-92. doi:10.1016/j.maturitas.2015.02.003

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