Menopause Society moderates HT stance, warns about 'bioidentical' hormone products.(News)

WASHINGTON -- The latest position statement on hormone therapy in peri- and postmenopausal women issued by the North American Menopause Society moderates prior guidance on treatment duration and adds a new warning about "bioidentical" hormone products.

The statement, at 28 pages, differs from the report issued in September by the American College of Obstetricians and Gynecologists on hormone therapy (HT) in that it is more concise and indicates areas where consensus was not reached, said Wulf H. Utian, M.D., executive director of the North American Menopause Society and chair of the panel that prepared the guidelines. The report, released at the NAMS annual meeting last month, summarizes 21 recommendations for clinical practice where the expert panel reached consensus, and lists four areas where the NAMS HT Advisory Panel--13 experts in menopause-related health care--could not reach consensus.

Panel members used evidence-based data and clinical experience to reach the best conclusions they could for this third annual position paper on HT issued by the NAMS, Dr. Utian said.

As last year's report recommended, the report strongly endorses the use of estrogen therapy (ET) and combined estrogen-progestogen therapy (EPT) for treating moderate to severe menopause-related symptoms, such as hot flushes. This "remains the primary indication" for ET and EPT, the report says. Local (or topical) ET is "generally" recommended when therapy is considered "solely" for vulvar or vaginal atrophy symptoms.

Removal of a time-specific period for the duration of HT is one of the major changes that is "very different" from last year's statement, said Dr. Utian, the Arthur H. Bill Professor Emeritus of Reproductive Biology and Obstetrics and Gynecology at Case Western Reserve University, Cleveland. The panel concluded that a "general guiding principle should be for the lowest effective dose and time consistent with treatment goals." As long as there remains a clear indication for use and the woman is under medical supervision, is aware of the potential risks and benefits, and is motivated to continue with HT, "we think it is acceptable to continue with therapy," he said.

The paper also reaffirms the statement that ...