Here’s a summary of advice from the 2017 position statement on hormone therapy of the North American Menopause Society (NAMS), which appeared in the journal Menopause in July:
Unless contraindicated (see below), for the treatment of menopausal symptoms such as hot flashes, the sooner after the onset of menopause a woman starts hormone therapy, the lower her risk of adverse events such as stroke and blood clots. Conversely, the longer a woman waits, the greater the risks.
The point at which these risks outweigh the potential benefits of hormone therapy varies considerably, depending on variables such as a woman’s risk factors for cancer and cardiovascular disease, her medical history, and the severity of her menopausal symptoms, but this point is generally reachedsomewhere between 10 and 20 years after the onset of menopause or between ages 60 and 70, whichever occurs first.
Because of the considerable individual variability in when the critical point is reached, a woman considering hormone therapy should discuss her risk/benefit profile with her health care provider.“Treatment should be individualized to identify the most appropriate hormone therapy type, dose, formulation, route of administration, and duration of use,” according to the statement.
Contraindications for hormone therapy include unexplained vaginal bleeding, coronary heart disease, stroke, thromboembolic disease, and certain types of breast and uterine cancers. Your health care provider will review your medical and family history to make sure you don’t have these or any other contraindications before starting hormone therapy.
For genital and urinary symptoms not relieved with over-the-counter or other therapies, low-dose vaginal estrogen therapy is recommended.