Menopausal Hormone Therapy.
Hormones are chemical messengers in the bloodstream that regulate many critical body functions such as temperature, digestion, sexuality, reproduction, and bone generation. Menopausal hormone therapy (MHT) has been scientifically-proven to decrease the intensity of several of the many women’s menopausal transition symptoms, specifically hot flashes and night sweats, bone loss and vaginal dryness. It has also been proven to reduce future health complications related to hormonal change such as dementia, heart attack and stroke, osteoporosis and vaginal atrophy.
Different hormones are needed depending on whether or not a woman still has a uterus, and it is important to work with a medically-licensed healthcare practitioner to determine what is best for you.
Your body has preferred levels of hormones that allow it to function at its best. It is normal for hormone levels to change as you age, but sometimes the change in the female hormone cycle can cause symptoms that affect your quality of life. The 2022 hormone therapy position statement of The North American Menopause Society (NAMS) declares that Menopause Hormone Therapy (MHT) remains the most effective treatment for vasomotor symptoms (VMS) and the genitourinary syndrome of menopause (GSM), and has been shown to prevent bone loss and fracture. The risks of MHT differ depending on which type of MHT is prescribed as well as the dose and the length of time the MHT is taken. When MHT starts and whether or not a progestogen is used also affects risk.
Duration of Use, Initiation After Age 60 years, and Discontinuation of Hormone Therapy.
The benefits of hormone therapy outweigh the risks for healthy women with bothersome menopause symptoms who are aged younger than 60 years or within 10 years of menopause onset. However, the risk of MHT does increase the older women are and the longer MHT is used. As such, women are advised to use the appropriate dose for the time needed to manage their symptoms. Many women experience bothersome symptoms for many years, so long-duration hormone therapy use may be needed.
This should be assessed on an individual basis, so creating arbitrary age-based guidance on when to stop using MHT is not clinically appropriate.
1. The safety profile of hormone therapy is best when it is started in healthy women aged younger than 60 years or within 10 years of menopause onset. Starting hormone therapy by menopausal women aged older than 60 years requires careful consideration of individual benefits and risks.
2. Long-term use of hormone therapy, including for women aged older than 60 years, may be considered in healthy women at low risk of cardiovascular disease and breast cancer if they are experiencing persistent VMS or are at an elevated risk of fracture, if other therapies are not appropriate.
3. Factors that should be considered include severity of symptoms, effectiveness of alternative non hormonal interventions, and underlying risk for osteoporosis, coronary heart disease, loss of blood flow to part of the brain (cerebrovascular accidents), blood clots, and breast cancer.
4. Hormone therapy does not need to be routinely discontinued in women aged older than 60 or 65 years.
5. Managing the risk of MHT by using the lowest effective dose and non-oral routes of administration (if possible) becomes increasingly important as women age and with longer duration of therapy.
6. Managing the risk of MHT by using the lowest effective dose and non-oral routes of administration (if possible) becomes increasingly important as women age and with longer duration of therapy.
7. Longer durations or extended use beyond age 65 should include periodic re-evaluation of risks and benefits, and consideration of periodic trials of lowering or discontinuing hormone therapy.
8. For women with GSM, low-dose vaginal ET may be considered for use at any age and for an extended duration, if needed.
9. Unless there are strong medical reasons, a woman should determine her preferred hormone therapy formulation, dose, and duration of use based on continued assessment and shared decision-making with her healthcare professional.
2. Long-term use of hormone therapy, including for women aged older than 60 years, may be considered in healthy women at low risk of cardiovascular disease and breast cancer if they are experiencing persistent VMS or are at an elevated risk of fracture, if other therapies are not appropriate.
3. Factors that should be considered include severity of symptoms, effectiveness of alternative non hormonal interventions, and underlying risk for osteoporosis, coronary heart disease, loss of blood flow to part of the brain (cerebrovascular accidents), blood clots, and breast cancer.
4. Hormone therapy does not need to be routinely discontinued in women aged older than 60 or 65 years.
5. Managing the risk of MHT by using the lowest effective dose and non-oral routes of administration (if possible) becomes increasingly important as women age and with longer duration of therapy.
6. Managing the risk of MHT by using the lowest effective dose and non-oral routes of administration (if possible) becomes increasingly important as women age and with longer duration of therapy.
7. Longer durations or extended use beyond age 65 should include periodic re-evaluation of risks and benefits, and consideration of periodic trials of lowering or discontinuing hormone therapy.
8. For women with GSM, low-dose vaginal ET may be considered for use at any age and for an extended duration, if needed.
9. Unless there are strong medical reasons, a woman should determine her preferred hormone therapy formulation, dose, and duration of use based on continued assessment and shared decision-making with her healthcare professional.