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Bioidentical Hormone Replacement Therapy

Key Points of the North American Menopause Society (NAMS) Position Statement on Hormone Replacement Therapy (HRT) for Women

By August 18, 2022January 16th, 2023No Comments

The North American Menopause Society (NAMS) recently released a position statement regarding women’s hormone replacement therapy (HRT).

We’ve covered all the key points you need to know to keep you updated about the treatment.

RELATED: 5 Facts & Myths About Female Testosterone Replacement Therapy


What Is HRT for Women?

Hormone replacement therapy (HRT) for women is an efficient, safe, and sustainable treatment procedure aiming to normalize the female body’s hormone levels.

As women age, the body experiences diminished hormones, including estrogen and testosterone, resulting in various health issues. These problems may once appear mild and don’t affect women’s everyday life but may worsen over time if not appropriately managed.

Eventually, those impacts due to low hormones may become the “bothersome” menopause symptoms when a woman reaches the age of 45 or above.

Therefore, HRT for women helps those in trouble regain a better quality of life by bringing their hormone levels back to normal.

HRT comes in various forms, dosages, and formulations. A woman may take HRT through hormonal gels, transdermal patches, injections, or pellets. Yet, injections and pellets are the most common and believed to be superior in efficacy and safety.


Understanding Menopause Symptoms


Since HRT for women aims to normalize hormone levels in the female body and alleviate the troubles coming with the condition, it would help if you’re well aware of what scientists consider “menopause symptoms.”


Vasomotor Symptoms

So you’ve been struggling with those “exasperating” hot flashes and night sweats recently? Scientists call them “vasomotor symptoms.”

Vasomotor symptoms (VMS) are associated with diminished sleep quality, difficulty concentrating, reduced quality of life, and poorer health status.

According to NAMS, vasomotor symptoms persist for 7.4 years among menopausal women and are linked to cardiovascular, bone, and cognitive risks. By optimizing the body’s hormone levels, HRT reduces vasomotor symptom frequency by 75% and significantly reduces symptom severity.

The position statement also shows that there are no differences in terms of efficacy between oral and non-oral formulations on vasomotor symptoms. In addition, lower doses of hormone therapy may take 6 to 8 weeks to provide adequate relief for vasomotor symptoms.

If you’ve used HRT and noticed that your life was better, but the problems returned once the therapy was discontinued, you are not alone. NAMS found that vasomotor symptoms return in approximately 50% of women when the treatment ends.


Sleep Disturbances

Many menopausal women open up about their stories when consulting their doctors, saying they’re obsessed with those nights when they couldn’t sleep.

Sleep disturbances begin in perimenopause and are common after menopause. These problems lead to poorer sleep quality, mood fluctuations, memory problems, metabolic syndrome, obesity, and other cardiovascular risk factors.

The NAMS position statement mentioned 23 studies on hormone therapy in the form of low-dose estrogen or progestogen, 14 of which showed positive results in improving sleep disturbances in menopausal women.

On the other hand, oral micronized progesterone (MP) has sedative effects without affecting cognition during the day, hence should only be used at night. In addition, it has been concluded that MP can improve postmenopausal women’s sleep latency but not sleep duration or quality.

RELATED: Is a Hormone Imbalance Affecting Your Sleep?


Genitourinary Symptoms

The genitourinary symptoms include the signs and symptoms associated with menopause-related estrogen deficiency, including changes to the:

  • Labia
  • Vagina
  • Urethra
  • Bladder


Changes may include vulvovaginal atrophy (thinning of the vaginal walls), genital dryness, burning, and irritation that lead to pain during sexual activity. Other symptoms include urinary urgency, dysuria (discomfort or burning with urination), and recurrent urinary tract infections (UTI).

The good news is that HRT for women, specifically vaginal estrogen therapy, is an effective treatment for genitourinary symptoms.


Urinary Tract Symptoms

Vaginal estrogen therapy also improves the symptoms related to the urinary tract by increasing the number of vessels around the bladder neck region. In addition, the treatment has been shown to affect the contractions of the muscles around the bladder to promote bladder muscle relaxation.


Sexual Function

HRT for women can improve sexual problems by increasing lubrication, blood flow, and sensation in vaginal tissues. However, the next time you consider the therapy, your healthcare provider may recommend transdermal HRT to you since it has been found that oral HRT is not as effective in improving libido in women.


What Are the FDA-approved Indications for HRT?

Vasomotor Symptoms


Hormone therapy is FDA-approved for women with moderate to severe vasomotor symptoms due to menopause.


Prevention of Bone Loss

Hormone therapy is FDA-approved for the prevention, but not treatment, of bone loss in postmenopausal women without osteoporosis.


Premature Hypoestrogenism

Hormone therapy is FDA-approved for women with estrogen deficiency, surgical removal of both ovaries, or primary ovarian insufficiency.


Genitourinary Symptoms

Hormone therapy is FDA approved for women with moderate to severe vulvovaginal atrophy and painful intercourse due to menopause.


What Are the Latest Findings About HRT Safety?

HRT Is Associated With Minimal Risks


HRT and Breast Cancer

In specific doses and formulations, HRT has increased the risk of breast cancer.

Specifically, a higher incidence of breast cancer has been seen in women on combined conjugated equine estrogens (CEE) and medroxyprogesterone acetate (MPA). Otherwise, CEE or MPA alone does not cause any similar side effects. CEE alone has actually been found to reduce breast cancer risk.

Other research has shown that breast cancer risk was increased in women using either systemic estrogen therapy or estrogen plus progestogen therapy (EPT). However, the increased incidence was “duration-dependent,” meaning that it only occurs during a specific duration of the treatment.


HRT and Other Morbidities

Research on people above 60 with comorbidities shows that EPT is associated with small increases in the risk of:

  • A coronary event (after one year)
  • Venous thromboembolism (VTE) (after one year)
  • Stroke (after three years)
  • Breast cancer (after five years)
  • Gallbladder disease (after five years)


On the other hand, ET (estrogen therapy) increases the risk of:

  • VTE (after 1-2 years)
  • Stroke (after seven years)
  • Gallbladder disease (after seven years)


HRT Risks Depend on Many Factors

Not everyone taking HRT is exposed to the same risks of side effects since multiple factors, including dosage, the route of administration, formulation, regimen, and even the timing of the therapy, lead to different outcomes.

The ideal goal when taking HRT is to use the most appropriate, often lowest, yet adequately effective hormone dose to produce consistent and sustainable results.

Controlling the quantity is crucial, as even when the side effects of the therapy appear, adjusting how much hormone you’re taking may help manage and reverse the conditions.


HRT Benefits Outweigh Risks

Despite the association of HRT with the risks of side effects at a minimal level, the NAMS report confirms that HRT benefits outweigh the risks. On this account, women should prioritize taking HRT following the recommendations to prevent and manage menopause symptoms while efficiently minimizing the side effects.

RELATED: HRT Could Help Dementia and Alzheimer’s in Women, Studies Show


Does the Timing of HRT for Women Matter?

Yes, when you get HRT does matter. Different timing of HRT initiation produces distinct effects.


Initiation Before Age 60 Years

According to NAMS, women from 50 to 59 or within ten years of menopause onset have a low risk of side effects due to HRT.


Initiation After Age 60 Years

In contrast, the risks of side effects due to HRT among those aged 60 years and older or who are further than ten years from menopause onset are more significant. Therefore, the initiation of HRT for women in this age group requires careful consideration.


How Long Can HRT for Women Be Safely Used?


Are you wondering how long you can safely take HRT and when you’ve had enough of the therapy? Many people have the same question as you do.

Controversies exist regarding the optimal duration of hormone therapy and when it should be discontinued.

According to NAMS:

  • Breast cancer risk is detectable after 3-5 years in women using EPT (estrogen plus progestogen therapy). Therefore, you can safely use EPT in less than 3-5 years.
  • Breast cancer risk does not increase after seven years among women using ET. Therefore, you can safely take ET (estrogen therapy) for longer than seven years.


However, the NAMS report also mentions that:

  • Vasomotor symptoms may recur in approximately 50% of women after HRT discontinuation.
  • HRT protection against bone density loss due to osteoporosis is lost rapidly after therapy discontinuation.


Therefore, before stopping HRT to prevent the side effects, you should consider all the disadvantages due to the suspension of the therapy, like the recurrence of menopause symptoms.

And, since each individual responds to the therapy differently, always consult with your doctor and request periodical evaluation to accurately determine whether the treatment is working correctly on you without any safety issues.

That’s everything you need to know about the 2022 hormone therapy position statement from The North American Menopause Society. We hope you’ve been well informed of the latest information about the therapy and are ready for the next journey to regaining youthful health with HRT.


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