Perimenopause library · Treatment literacy
What NAMS currently says about hormone and nonhormone options
Treatment decisions belong with you and a qualified clinician. What follows is a description of two position statements from The Menopause Society (NAMS), not advice to start, stop, or refuse a medicine.
The 2022 hormone therapy statement says hormone therapy remains the most effective treatment for bothersome vasomotor symptoms and for genitourinary syndrome of menopause, and that it prevents bone loss and fracture. Benefit-risk is described as generally more favorable under age 60, or within ten years of menopause, when there are no contraindications. It is described as less favorable if therapy starts more than ten years after menopause or after age 60, because absolute risks of coronary disease, stroke, blood clots, and dementia rise in that later window.
Risks depend on type, dose, duration, route, timing, and whether a progestogen is used. NAMS asks clinicians to individualize and reassess. The Women’s Health Initiative used one oral conjugated estrogen regimen, with or without medroxyprogesterone, and under-enrolled younger, very symptomatic people. NAMS says not to treat that trial as the whole hormone-therapy story.
The 2023 nonhormone statement lists options with evidence grades for vasomotor symptoms. Recommended at Level I: cognitive behavioural therapy, clinical hypnosis, SSRI/SNRI medicines, gabapentin, and fezolinetant. Oxybutynin sits at I–II. Weight loss and stellate ganglion block sit at II–III. A long list is not recommended as vasomotor treatment, including most supplements and herbals, soy, cannabinoids, acupuncture, paced respiration, and exercise or yoga used specifically as hot-flash therapy. Exercise and yoga can still matter for other health goals; the statement is about treating flashes.
Hormone therapy is still described as the most effective option for vasomotor symptoms and should be considered, when appropriate, within ten years of the final menstrual period. “When appropriate” is a clinical judgment. ClearDay will not make it.
What this article cannot tell you
- Whether hormone therapy is safe or appropriate for you.
- Which nonhormone option would work in your case.
- How to dose, start, or stop any medicine.
Questions worth taking to a clinician
- Given my age, last period, and history, am I inside the NAMS window they describe as more favorable?
- If hormone therapy is not an option for me, which nonhormone options in the 2023 statement fit my situation?
- Which popular supplements should I stop treating as proven flash therapy?
Sources
- The North American Menopause Society. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022. doi:10.1097/GME.0000000000002028
- The North American Menopause Society. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023. doi:10.1097/gme.0000000000002200