NAMS Publishes New Position Statement on Hormone Therapy

NAMS Publishes New Position Statement on Hormone Therapy

Before the year 2000, estrogen was the #1 prescribed medication in the United States. It was used by over 40% of all women in perimenopause and menopause, seemed safe, and doctors freely prescribed HT because it definitely improved the menopause symptoms it was intended to treat and seemed safe.


Then in 2002 came the Women’s Health Initiative Study called the WHI study. 


The WHI study included tens of thousands of women to provide a well designed study that proved once and for all the safety and effectiveness of estrogen and hormone therapy (HT).


It turns out the WHI was a very flawed study because there was a design flaw that let in way too many women who were between the ages of 60 to 79, and way too few women between the ages of 50 to 59. Most of the HT went to women ages 60 to 79 year old; most of the placebo pills went to women ages 50 to 59 year old women.


So the study found out what we all know: older women have a higher risk of breast cancer and heart disease and some other things than younger women. The researchers didn’t realize it was the groups ages and not HT that created the differences in risk.  


That little bit of human error caused a generation of women to stop taking HT. Today less than 5 percent of women are on HT and most of the rest are taking nothing. There are just suffering and trying to tough it out because they are not sure what to do, because their doctor told them HT was not safe, because they are afraid, confused or have just given up on getting the help they need.


And that’s bad for women personally, and in the workplace.


The WHI study also stopped a generation of doctors from learning about HT and how and when to prescribe it. Only about 1 in 5 Ob/Gyn residents get any training on menopause or HT. Only about 1 in 10 family practice and primary care residents get any menopause training.


But 100 percent of women who live long enough get menopause.


It’s pretty hard to admit a mistake and it took years and years to get it right. Now, after looking at the original WHI study and reanalyzing the same information, the same study shows us that “Estrogen is safe and effective for most women.”


Who knew???


It turns out that experts in the field of menopause knew and know. And The North American Menopause Society (NAMS) has just published its latest position statement on hormone therapy (HT) to include what we have learned over the past two decades… HT is safe and effective for most women, plus a lot more specific information.


NAMS is an extremely reliable resource. It position statement has been endorsed by 20 well respected medical organizations.


As I explained in my best-selling book, The Estrogen Fix, estrogen is safe and the most effective treatment for menopause symptoms in the vast majority of women. And women with early menopause, before age 45, are much better off taking HT than not, at least until the time of natural menopause, which is age 51.


Transdermal (through the skin) seems a bit safer than oral HT, and compounded hormones are not believed as safe as those from traditional drug stores.


You don’t have to absolutely stop taking hormones because you reached 60 or 65, and vaginal estrogen seems safe.


The highlights of the NAMS 2022 HT Position Statement are shown below. If you’d like to read the entire position statement, CLICK HERE.


“Highlights from the NAMS 2022 Hormone Therapy Position Statement include

  • Hormone therapy remains the most effective menopause treatment for hot flashes and the genitourinary syndrome of menopause (GSM–represents dry vagina, itching, dry sensitive vulva, urinary symptoms) and has been shown to prevent bone loss and fracture.
  • Personalization with shared decision-making remains key, with periodic reevaluation to determine an individual woman’s benefit-risk profile, with recommendations for the use of the appropriate dose, duration, regimen, and route of administration required to manage a woman’s symptoms and to meet treatment goals.
  • Risk stratification by age and time since menopause is recommended.
  • The benefits of hormone therapy outweigh the risks for most healthy symptomatic women who are aged younger than 60 years and within 10 years of menopause onset.
  • Transdermal routes of administration and lower doses of hormone therapy may decrease risk of venous thromboembolism and stroke.
  • Women with primary ovarian insufficiency and premature or early menopause have higher risks of bone loss, heart disease, and cognitive or affective disorders associated with estrogen deficiency. It is recommended that hormone therapy can be used until at least the mean age of menopause unless there is a contraindication to its use.
  • There is a paucity of randomized, controlled trial data about the risks of extended duration of hormone therapy in women aged older than 60 or 65 years, although observational studies suggest a potential rare risk of breast cancer with increased duration of hormone therapy.
  • For select survivors of breast and endometrial cancer, observational data show that use of low-dose vaginal estrogen therapy for those who fail non-hormone therapy for treatment of GSM appears safe and greatly improves quality of life for many.
  • Breast cancer risk does not increase appreciably with short-term use of estrogen-progestogen therapy and may be decreased with estrogen alone.
  • Compounded bioidentical hormone therapy presents safety concerns, such as minimal government regulation and monitoring, overdosing or underdosing, presence of impurities or lack of sterility, lack of scientific efficacy and safety data, and lack of a label outlining risks.
  • Hormone therapy does not need to be routinely discontinued in women aged older than 60 or 65 years and can be considered for continuation beyond age 65 for persistent VMS, quality-of-life issues, or prevention of osteoporosis after appropriate evaluation and counseling of benefits and risks.
  • For women with GSM, vaginal estrogen (and systemic if required) or other non-estrogen therapies may be used at any age and for extended duration, if needed.”


If you are looking for help understanding hormones and their alternatives, how we know it is safe for most women, when and how to take them, and what your alternatives to estrogen are, visit to see if menopause coaching is right for you.

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