“For women who initiate HT more than 10 or 20 years from menopause onset or when aged 60 years or older, the benefit-risk ratio appears less favorable than for…”.1

Umbrella
What may the Hormone Therapy and Aging Umbrella include?

Depending on the Source (DotS) this Umbrella may include:

  • Hormone Replacement Therapy (HRT) and Aging/Prevention/Protection
  • Hormone Therapy (HT) and Aging/Prevention/Protection
  • Menopausal Hormone Therapy (MHT) and Aging/Prevention/Protection

Chronic Conditions

Is there an association between hormone therapy (HT) and the prevention of chronic conditions?

In December 2017, the (United States) Preventative Services Task Force (USPSTF) updated their 2012 recommendations about the use of HT in postmenopausal women for the primary prevention of chronic conditions.

Hormone Therapy and AgingIn Hormone Therapy In Postmenopausal Women: Primary Prevention of Chronic Conditions – Recommendation Summary the USPSTF recommend:

“Postmenopausal women
The USPSTF recommends against the use of combined estrogen and progestin for the primary prevention of chronic conditions in postmenopausal women”.2

Hormone Therapy and AgingIn Hormone Therapy In Postmenopausal Women: Primary Prevention of Chronic Conditions – Recommendation Summary, the USPSTF recommend:

“Postmenopausal women who have had a hysterectomy
The USPSTF recommends against the use of estrogen alone for the primary prevention of chronic conditions in postmenopausal women who have had a hysterectomy”.3

Osteoporosis

How may osteoporosis be prevented?

In Menopause FAQs: Your Health After Menopause – Q. What can I do to prevent osteoporosis? the NAMS elaborate on

“A. …Talk to your healthcare provider about your risk of osteoporosis and what you can do to help keep your bones strong, especially with good nutrition and exercise”.4

Heart Disease

How may heart disease be prevented?

In Menopause FAQs: Your Health After Menopause – Q. Do I have to start worrying about heart disease? the NAMS elaborate on:

“A. You do. Although many women think of heart disease as a man’s disease, the number one killer of women in North America is cardiovascular disease, that is, diseases of the heart and circulatory system. After age 55, more than half of all the deaths in women are caused by cardiovascular disease. Risk for this disease increases after menopause. Be sure to talk to your healthcare team about what your risks are and how you can reduce them”.5

Benefits and Risks

For older women, what is the HT benefit-risk ratio?

On page one in NAMS 2017 Position Statement Updates Guidelines for Hormone Therapy Use published 20 June 2017, the NAMS explain:

  • “For women who initiate HT more than 10 or 20 years from menopause onset or when aged 60 years or older, the benefit-risk ratio appears less favorable than for younger women because of greater absolute risks of coronary heart disease, stroke, venous thromboembolism, and dementia”.6

On page one in Deciding About Hormone Therapy Use: Potential Risks published in June 2017, the NAMS also elaborate on:

  • “As with all medications, HT is associated with some potential risks. For healthy women aged younger than 60 years with bothersome hot flashes who are within 10 years of menopause, the benefits of HT generally outweigh the risks. Hormone therapy might slightly increase your risk of stroke or blood clots in the legs or lungs (especially if taken in pill form). If started in women aged older than 65 years, HT might increase the risk of dementia. If you have a uterus and take estrogen with progestogen, there is no increased risk of cancer of the uterus. Hormone therapy (combined estrogen and progestogen) might slightly increase your risk of breast cancer if used for more than 4 to 5 years. Using estrogen alone (for women without a uterus) does not increase breast cancer risk at 7 years but may increase risk if used for a longer time”.7

Stop or Not

If I am an older woman, do I need to discontinue HT?

On page one in the NAMS 2017 Position Statement Updates Guidelines for Hormone Therapy Use published 20 June 2017 the NAMS elaborate on:

  • “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 years for persistent hot flashes, quality-of-life issues, or prevention of osteoporosis after appropriate evaluation and counseling of benefits and risks”.8

Health Care Provider

What if I would like to choose to use HT to prevent aging?

If you would like to choose to use HT to prevent aging, it may be in your best interest to also choose to talk to your health care provider about this.

One of the points of consensus about menopausal hormone therapy (MHT) in the Revised Global Consensus Statement on Menopausal Hormone Therapy: Section B: General Principles Governing the Use of MHT – endorsed by seven menopause-related organizations – published online 20 June 2016, is:

  • “The option of MHT is an individual decision in terms of quality of life and health priorities as well as personal risk factors such as age, time since menopause and the risk of VTE, stroke, ischemic heart disease and breast cancer. MHT should not be recommended without a clear indication for its use”.9

What is VTE?

VTE can be an abbreviation for Venous Thromboembolism.

On page two in the NAMS 2017 Position Statement Updates Guidelines for Hormone Therapy Use published 20 June 2017 the NAMS’s current president reassures older women and elaborates on:

““…women older than 65 years old will be relieved to know that they don’t have to stop using hormone therapy for their bothersome hot flashes just because of their age. The data simply do not support it, but individualized evaluation and discussion is recommended””.10

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Sources

  1. Deciding About Hormone Therapy Use: Potential Risks. 2017:2. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/menonote-deciding-about-ht-2017.pdf Accessed: 08 October 2020
  2. Hormone Therapy In Postmenopausal Women: Primary Prevention of Chronic Conditions – Recommendation Summary. 12 December 2017. U.S. Preventative Services Task Force https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/menopausal-hormone-therapy-preventive-medication Accessed: 08 October 2020
  3. Hormone Therapy In Postmenopausal Women: Primary Prevention of Chronic Conditions – Recommendation Summary. 12 December 2017. U.S. Preventative Services Task Force https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/menopausal-hormone-therapy-preventive-medication Accessed: 08 October 2020
  4. Menopause FAQs: Your Health After Menopause – Q. What can I do to prevent osteoporosis? North American Menopause Society https://www.menopause.org/for-women/menopause-faqs-your-health-after-menopause Accessed: 08 October 2020
  5. Menopause FAQs: Your Health After Menopause – Q. Do I have to start worrying about heart disease? North American Menopause Society https://www.menopause.org/for-women/menopause-faqs-your-health-after-menopause Accessed: 08 October 2020
  6. NAMS 2017 Position Statement Updates Guidelines for Hormone Therapy Use. 20 June 2017:1. North American Menopause Society https://www.menopause.org/docs/default-source/default-document-library/ht-press-release-061917.pdf Accessed: 08 October 2020
  7. Deciding About Hormone Therapy Use: Potential Risks. 2017:2. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/menonote-deciding-about-ht-2017.pdf Accessed: 08 October 2020
  8. NAMS 2017 Position Statement Updates Guidelines for Hormone Therapy Use. 20 June 2017:1. North American Menopause Society https://www.menopause.org/docs/default-source/default-document-library/ht-press-release-061917.pdf Accessed: 08 October 2020
  9. De Villiers, T. J., Hall, J. E., Pinkerton, J. V., Pérez, S. C., Rees, M., Yang, C. and Pierroz, D. D. Revised Global Consensus Statement on Menopausal Hormone Therapy: Section B: General Principles Governing the Use of MHT. Climacteric, 2016;19:4:314 https://www.imsociety.org/manage/images/pdf/ba6379e868044bec13015ac2b84f2753.pdf Accessed: 08 October 2020
  10. NAMS 2017 Position Statement Updates Guidelines for Hormone Therapy Use. 20 June 2017:2. North American Menopause Society https://www.menopause.org/docs/default-source/default-document-library/ht-press-release-061917.pdf Accessed: 08 October 2020

Topic Last Updated: 08 October 2020 – Topic Last Reviewed: 08 October 2020
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