The North American Menopause Society, NAMS,  has recently released a new position paper on the use of hormone therapy during and following menopause. An analysis of several studies and data has shown that hormone therapy is not as dangerous or onerous as believed 10 years ago after the initial release of the Women’s Health Initiate study results.

The Women’s Health Initiative was designed to determine if HRT was cardioprotective; as well as to help determine if HRT caused an increase in breast cancer. This study was stopped prematurely due to an increase in cardiovascular events including stroke, heart attack and blood clots. Hormone therapy was quickly blamed for this increase in cardiovascular events, and consequently usage has plummeted.

You may be asking what is new about all this information?

Researchers have been continuing to analyze the data from this study, and have come to some conclusions which have helped guide NAM’s new position paper. This is what they have determined:

1. Most cardiac events occurred in women over 60 who were placed on hormone therapy 10 or more years after menopause.
2. Women who underwent hysterectomy and were placed on estrogen without progesterone had a lower rate of breast cancer, therefore taking estrogen for up to 7-8 yrs was not associated with increase risk of breast cancer.
3. However, HRT started at time of menopause was associated with slightly higher risk of breast cancer than when started a few years post menopause.
4. Women on estrogen therapy (ET) and estrogen/progesterone therapy(EPT) had lower rate of cardiovascular events when HRT was started at time of menopause, as opposed to several years post menopause.
5. The types of estrogen and types of progesterone may influence risk of breast cancer and cardiac events.

What does this mean for you?

The recommendations suggest that you can expect the have your hormone therapy customized to your particular medical situation,  including consideration for your risk for breast disease and heart disease.

For those of you who have had a hysterectomy, you could reasonably take your estrogen therapy for up to 7 years without significantly increasing your risk of breast cancer.

For those of you who still have a uterus, you would want to limit your use of HT for 3-5 years. After this, your risk of breast cancer increases.

The type of progesterone therapy may affect the risk of cardiovascular events. A natural progesterone, such as Prometrium, may have significantly less risk than synthetic progesterone, for both cardiovascular events and possibly breast cancer.

The route of delivery of estrogen may lessen the risk of HT. Topical estrogen, or estrogen patches may have less risk of thrombotic events; than oral estrogen.

Estrogen is the most effective therapy for vulva and vaginal atrophy, with topical vaginal cream, ring and suppositories being superior to oral estrogen.

Compounded Bio-identical hormones should only be used if an allergy to a component of federally approved estrogen or progestin hormone therapy exists. These compounded hormones have not been tested and may contain levels of hormones or ingredients that are harmful. For this reason,  safety cannot be established as clinical trials proving safety have not been performed.

Hormone therapy can be very helpful when you are first experiencing menopausal symptoms. Now, with this statement paper, there is more guidance on safety of HRT use. Compounded Bio-identical Hormones are very popular, but their safety has not been establishes in the types of studies that this position paper discusses. There are many safe options for women that include patches, creams as well as pills; and this allows flexibility in dosing. This is is a form of customization.

This is information that you can use when you see your medical provider. Write in and share your own experience with HRT and whether or not it has helped, and even which preparation you used (your information is anonymous to our readers). It is through sharing information that we can enlighten one another about menopause and strategies to ease the common problems.