Every few years The Menopause Society (until 2023 called the North American Menopause Society, or NAMS) publishes a position statement on hormone therapy that summarizes the evidence and gives clinicians a reference point. The 2022 statement is the current one. This post explains what it says, who it is for, and what it does not say. It is a summary; the full statement is linked at the end and is worth reading if you are considering treatment.
What the statement is
A position statement is not a trial. It is a review, written by a panel of specialists, of the trials and observational studies that existed at the time, with conclusions and advice drawn from them. The 2022 statement updates the 2017 version and runs to about thirty pages in the journal Menopause.
Hormone therapy in the statement means estrogen, with or without a progestogen, taken for menopause symptoms. It covers tablets, patches, gels, sprays, and vaginal products, and it distinguishes between them where the evidence does.
The main conclusions
Hormone therapy is the most effective treatment for hot flashes and night sweats
This is stated plainly. The statement also notes benefits for genitourinary symptoms, such as vaginal dryness, and for preventing bone loss and fracture.
Benefits most likely outweigh risks for symptomatic women under 60 or within ten years of their final period
This is the sentence most often quoted, and it is worth reading carefully. It applies to women with bothersome symptoms, without contraindications, in that age or timing window. It is a statement about the balance for a group, which is why the next point matters.
Risk is individual
The statement says risks differ by type of hormone, dose, route (for example, a patch versus a tablet), how long treatment lasts, when it starts, and whether a progestogen is used. It asks clinicians to weigh each woman’s own history rather than apply a single rule. Family and personal history of breast cancer, blood clots, stroke, and cardiovascular disease are central to that weighing.
Starting later carries a less favorable balance
For women who start hormone therapy more than ten years after menopause or after 60, the statement describes a less favorable balance, mainly because of higher risks of heart disease, stroke, and blood clots in that group. It does not say treatment is impossible after 60; it says the decision needs more care.
No arbitrary stopping age
Earlier guidance often implied treatment should stop after a fixed number of years. The 2022 statement does not set a stopping age. It advises periodic reassessment, with the decision to continue based on symptoms and risk at that time.
Not for prevention of heart disease or dementia
The statement does not recommend hormone therapy for preventing cardiovascular disease, dementia, or cognitive decline. Earlier hopes that it might were not supported by the trial evidence.
What changed from earlier advice
The biggest shift happened before 2022 and the statement consolidates it. After the Women’s Health Initiative trials were first reported in 2002, hormone therapy use fell sharply on the basis of risks that, with more analysis, turned out to depend heavily on the age of the women studied. Many participants were well past menopause when they started. Later analyses by age group showed a different picture for younger women, which is where the “under 60 or within ten years” framing comes from. The research hub has a separate summary of the WHI.
The 2022 statement also gives more weight to the route of estrogen. Transdermal estrogen (patch or gel) appears to carry a lower risk of blood clots than tablets in observational studies, though the statement is careful about the strength of that evidence.
Limits of the statement
- It is a North American document. UK guidance from NICE (NG23) reaches broadly similar conclusions but is organized differently, and prescribing norms differ between countries.
- Much of the long-term safety evidence still comes from the WHI, which used specific hormone preparations that are less common today.
- The statement acknowledges that evidence for women with early menopause, and for women from underrepresented groups, is thinner.
Where to read it
The full text is published in Menopause and is available free through The Menopause Society. The citation and link are below.
Sources
- The 2022 Hormone Therapy Position Statement of The North American Menopause Society · Menopause, 29(7):767–794, 2022
- Position statements · The Menopause Society
- Menopause: identification and management (NG23) · NICE, 2024
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