Great Big News in the Menopause World

5 minute read

By: Sharon D. Malone, MD|Last updated: November 7, 2022

The North American Menopause Society (NAMS) has issued updated guidelines on hormones. This is a pretty big deal. At Alloy, we believe you should base your medical decision on facts, not fear, and so does NAMS. They’re the leading organization when it comes to menopause care, and we base our treatments on their guidelines. 

They’ve released their 2022 position statement, and ALL of the news is good news.

There’s a lot to unpack in the statement, but I won’t bury the lede: 

For the vast majority of healthy, symptomatic women, estrogen therapy is THE most effective treatment for relief of vasomotor symptoms (hot flashes), and the benefits of use far exceed any risks.

The latest statement stresses what so many of us have been advocating for years. The decision to take hormones, or not to take them, should be based on sound science. The decision should involve the patient, and not just a physician acting as a gatekeeper. Whether or not to take hormones should be based on treatment goals and expectations, and a fair and unbiased assessment of an individual’s risks and benefits:

“The decision regarding the duration of treatment and when to stop hormone therapy must be considered in the context of the individualized risk-benefit profile, as well as the woman’s personal preferences.”

This is music to our ears.

At Alloy, we trust that women given adequate information are more than capable of making decisions about their own health.

Some highlights from the new NAMS guidelines:

  • There’s no difference between transdermal and oral estrogen in relieving hot flashes.

  • Menopausal Hormone Treatment (MHT) users have a reduced risk for bone loss, fractures, and deaths from all causes. For women who take estrogen only, there is a reduced risk of breast cancer and type 2 diabetes.

  • Vaginal estrogen for treatment of vaginal dryness and urinary symptoms can be used safely, even in women with a history of breast cancer.

Menopause & Breast Cancer

The number one reason why women avoid the use of MHT is the fear of breast cancer. And yet, the news about breast cancer and MHT is actually quite encouraging.

Here’s the deal. Breast cancer is common. One in eight women will be diagnosed with breast cancer in her lifetime. But, here’s the thing: You have to live to be over 80 to get to that risk level, since your risk increases as you age. The bigger question is: Does taking MHT add to that risk? And the answer is, not really. Even with the estrogen and progestin formulation used in the WHI, the increased risk of breast cancer that we can possibly attribute to hormones is less than one additional case of breast cancer, per 1,000 women, per year. This risk is similar to the additional risk of drinking more than one glass of wine per day.

More importantly, for women diagnosed with breast cancer while on hormones, the risk of dying from breast cancer does not increase. New studies from the UK have shown no increase in breast cancer diagnosis for women who used estrogen and natural progesterone, and a study from Finland reported a reduction in deaths from breast cancer in women who took estrogen alone and who took estrogen and progestin.

In the meantime, there are things you can do to decrease your breast cancer risk.

  1. Drink fewer than two glasses of wine or alcohol per day

  2. Exercise regularly

  3. Maintain a healthy weight

  4. Get screened regularly for breast cancer

How long should you take MHT?

There are also some new guidelines about how long it is safe to use MHT. It used to be that it was recommended to take hormones for the least amount of time. But, the reality is that there was never any real science around any specific time frame about when to stop hormones. We kind of made it up. Some doctors only prescribed for two or three years, some for five years, and others recommended stopping at age 60. The resulting hodgepodge generated confusion among women (and physicians) because there was an assumption that a longer duration of treatment meant a greater risk of adverse effects. The evidence does not support this view. The new guidelines affirm the American College of Obstetricians and Gynecologists' position that there is no reason to routinely stop hormones at 65. Provided that women remain healthy and still are symptomatic when hormones are stopped, they may continue as long as they like. And, in fact, for women who are at risk for osteoporosis, continuing hormones after age 65 will confer even greater benefits with fewer resulting fractures.

The common denominator in these new guidelines is YOU. “In the absence of contraindications, a woman should determine her preferred hormone therapy formulation, dose and duration of use, with ongoing assessment and shared decision-making with her healthcare professional.” We at Alloy have always believed that women can and should be actively involved in decisions regarding their quality of life. Our job is to continue to provide you with science-backed information and expert opinions that help you with these decisions. The rest is up to you. And we trust women to make a choice that’s right for them.

The 2022 hormone therapy position statement of The North American Menopause Society

The Women's Health Initiative trials of menopausal hormone therapy: lessons learned

Breast cancer statistics, 2019 - DeSantis - 2019 - CA: A Cancer Journal for Clinicians - Wiley Online Library

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