Hormone Therapy for Post-Menopausal Women

NAMS (the North American Menopause Society) is an organization of physicians, researchers and experts whose mission is to “promote women’s health at midlife and beyond.” To this end, periodically they create a“position statement” summarizing the current body of evidence we have regarding menopausal health concerns. Below is a summary of the NAMS position statement from 2017.

NORTH AMERICAN MENOPAUSE SOCIETY (NAMS) POSITION STATEMENT 2017

Vasomotor symptoms (hot flashes and night sweats) last an average of 7 years and return in 50% of women who discontinue hormone therapy. Prescribers may consider compounded hormone therapy if women cannot tolerate a government-approved therapy.

BENEFITS OF ESTROGEN THERAPY

• Weight and metabolism: Hormone therapy decreases abdominal fat accumulation and reduces the risk of Type 2 Diabetes

• Genitourinary symptoms: Vaginal estrogen may improve incontinence by increasing the number of blood vessels around the peri-urethral and bladder neck region and reduces bladder contractions. Estrogen may also improve synthesis of collagen and improve vaginal epithelium.

• Sexual function: Transdermal or vaginal estrogen increases vaginal lubrication, blood flow and sensation.

• Cardiovascular disease: Women with early ovarian failure or surgical menopause have a higher risk of death from heart disease as well as from all causes compared with women who have a normal age of menopause which may be reflective of premature aging. Randomized controlled trials show that women who initiate hormone therapy younger than age 60 or within 10 years of menopause have a reduced risk of coronary heart disease, no increased risk of stroke, and a reduction in all-cause mortality.

• Eyes: May decrease the risk of cataracts and glaucoma.

• Skin and Hair: Estrogen increases epidermal and dermal thickness, increased collagen and elastin content, and improved skin moisture with fewer wrinkles. Biogerontology 2012

• Neurologic: Estrogen decreases dizziness and vertigo and improves postural balance. Evidence suggests that estrogen is neuro-protective and may reduce production of β-amyloid, the protein associated with Alzheimer’s disease.

• Bones: Estrogen decreases osteoporosis risk.

• GI: Estrogen reduces one's risk of colorectal cancer and is suggested to decrease fatty liver.

• Dementia: Four observational studies provide support for the view that timing of hormone therapy initiation is a significant determinant of Alzheimer disease risk, with early initiation lowering risk and later initiation associated with increased risk.

References

https://www.menopause.org/docs/default-source/2017/nams-2017-hormone-therapy-position-statement.pdf

https://www.ncbi.nlm.nih.gov/pubmed/21280086