Ultime linee guida pubblicate dal NAMS 2017
The 2017 Hormone Therapy Position Statement of The North American Menopause Society (NAMS) updates the
2012 Hormone Therapy Position Statement of The North American Menopause Society and identifies future research
needs.
An Advisory Panel of clinicians and researchers expert in the field of women’s health and menopause was
recruited by NAMS to review the 2012 Position Statement, evaluate new literature, assess the evidence, and reach
consensus on recommendations, using the level of evidence to identify the strength of recommendations and the quality
of the evidence.
The Panel’s recommendations were reviewed and approved by the NAMS Board of Trustees.
Hormone therapy (HT) remains the most effective treatment for vasomotor symptoms (VMS) and the genitourinary
syndrome of menopause (GSM) and has been shown to prevent bone loss and fracture. The risks of HT differ
depending on type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is
used. Treatment should be individualized to identify the most appropriate HT type, dose, formulation, route of
administration, and duration of use, using the best available evidence to maximize benefits and minimize risks, with
periodic reevaluation of the benefits and risks of continuing or discontinuing HT.
Forwomen aged younger than 60 years orwho arewithin 10 years ofmenopause onset and have no contraindications, the
benefit-risk ratio is most favorable for treatment of bothersome VM Sand for those at elevated risk for bone loss or fracture.
For women who initiate HT more than 10 or 20 years from menopause onset or are aged 60 years or older, the benefit-risk
ratio appears less favorable because of the greater absolute risks of coronary heart disease, stroke, venous thromboembolism,
and dementia.
Longer durations of therapy should be for documented indications such as persistentVMSor bone loss, with
shared decision making and periodic reevaluation. For bothersome GSM symptoms not relieved with over-the-counter
therapies andwithout indications foruse of systemicHT, low-dosevaginal estrogen therapy or other therapies are recommended.
