REF-1406 · The North American Menopause Society (NAMS) Hormone Therapy Position Statement Advisory Panel, 2022 · Menopause · Paper · PubMed

What does hormone therapy do, and who decides?

NAMS 2022: the most effective treatment for hot flushes; prevents bone loss; for these, benefit-risk favourable under 60 or <10 years from menopause, no contraindications. A doctor decides.

Main caveat: Read from the abstract only. The grades of individual recommendations, the evidence cited, panel membership, conflicts of interest and the method of literature…
strong evidenceMeasured on non-athletes and recreational people

The 2022 statement updates the society's 2017 hormone therapy position statement and identifies research needs.

An advisory panel of clinicians and researchers expert in women's health and menopause, recruited by NAMS, reviewed the 2017 statement, evaluated new literature, assessed the evidence and reached consensus on recommendations, "using the level of evidence to identify the strength of recommendations and the quality of the evidence"; the NAMS Board of Trustees reviewed and approved them.

The abstract's positions: hormone therapy remains the most effective treatment for vasomotor symptoms (VMS: hot flushes and night sweats) and for the genitourinary syndrome of menopause, and has been shown to prevent bone loss and fracture.

Its risks differ by type, dose, duration of use, route of administration, timing of initiation and whether a progestogen is used; treatment should be individualised on the best available evidence to maximise benefits and minimise risks, with periodic re-evaluation of whether to continue.

For women younger than 60 or within 10 years of menopause onset and without contraindications, the benefit-risk ratio is favourable for treating bothersome VMS and preventing bone loss; for women who start more than 10 years from onset or older than 60, it appears less favourable because of greater absolute risks of coronary heart disease, stroke, venous thromboembolism and dementia.

Longer durations should be for documented indications such as persistent VMS, with shared decision-making and periodic re-evaluation.

For bothersome genitourinary symptoms not relieved by over-the-counter therapies in women without indications for systemic therapy, low-dose vaginal oestrogen or other therapies (for example vaginal dehydroepiandrosterone or oral ospemifene) are recommended.

Our reading: the base had no clinical anchor for hormone therapy (REF-731 already sends "any conversation about menopausal hormone therapy" to a physician); this statement lets the assistant say what the treatment is for and how the decision is framed, without advising.

It does not support hormone therapy as a training or performance aid: the abstract does not address muscle or performance, and in randomised trials hormone therapy did not preserve lean mass (REF-1407).

Protocol

Process: advisory panel of clinicians and researchers in women's health and menopause, recruited by NAMS; reviewed the 2017 statement, evaluated new literature, assessed the evidence, reached consensus on recommendations, and rated the strength of recommendations and quality of evidence by level of evidence; approved by the NAMS Board of Trustees.
Not in the abstract: panel size and membership, the search method, the grading scale itself, which recommendation carries which grade, and the evidence base cited for each position.
Population addressed: peri- and postmenopausal women considering or using hormone therapy, framed by age (under or over 60) and time since menopause onset (within or beyond 10 years); athletes are not mentioned.
Funding and interests: not available from the abstract or the PubMed record; Crossref lists no funder. Panel disclosures, if printed, are in the unread full text. No device maker, federation or data platform is named.

Key Results

Positions as the abstract states them (grades not given in the abstract):

TopicPosition
EffectivenessMost effective treatment for vasomotor symptoms and the genitourinary syndrome of menopause
BoneShown to prevent bone loss and fracture
What risk depends onType, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is used
How to treatIndividualise with the best available evidence to maximise benefits and minimise risks; periodically re-evaluate the benefits and risks of continuing
Under 60, or within 10 years of menopause onset, no contraindicationsBenefit-risk ratio favourable for bothersome VMS and prevention of bone loss
Started more than 10 years from onset, or over 60Benefit-risk ratio appears less favourable: greater absolute risks of coronary heart disease, stroke, venous thromboembolism and dementia
Longer durationFor documented indications such as persistent VMS, with shared decision-making and periodic re-evaluation
Genitourinary symptoms not relieved by over-the-counter therapies, no indication for systemic therapyLow-dose vaginal oestrogen or other therapies (e.g. vaginal dehydroepiandrosterone, oral ospemifene) recommended
Grading: the abstract says the panel used "the level of evidence to identify the strength of recommendations and the quality of the evidence", but gives no grade for any position; which positions are strong recommendations and which rest on lower-quality evidence cannot be stated from the abstract.
What the abstract does not cover: muscle, strength, body composition, exercise, sport or performance; non-hormonal treatments for VMS (beyond the vaginal options named); hormonal contraception in perimenopause.

Mechanisms

Authors' interpretation: the balance of benefit and risk depends on when therapy starts relative to age and menopause onset, because the absolute risks of coronary heart disease, stroke, venous thromboembolism and dementia are greater in women who start later or older.
Inference: the window the statement calls favourable (under 60 or within 10 years of onset) overlaps the years of fastest menopausal bone loss, from about a year before to two years after the final period (REF-1404); the statement's bone-prevention position is about that loss, not about training.
Inference: none of the statement's positions concern muscle or exercise; the base's evidence on hormone therapy and muscle is REF-1407 (no lean-mass difference in randomised trials, low certainty).

Practical Application

What does hormone therapy do, and who decides? NAMS 2022: the most effective treatment for hot flushes; prevents bone loss; for these, benefit-risk favourable under 60 or <10 years from menopause, no contraindications. A doctor decides.
What the assistant says, and does not say: it can state the statement's positions above (A, position statement, from the abstract) and that the decision is individual and periodically re-evaluated with a clinician. It does not recommend, discourage, dose, start or stop hormone therapy, choose a type or route, or judge contraindications — not from this paper; the base's own practice, in line with REF-731's refer-out line.
Age 60 and 10 years are the statement's benefit-risk framing, not a switch: the abstract says the ratio is favourable in younger or recently menopausal women without contraindications and "appears less favorable" later; it does not say therapy is ruled out or ruled in at either line. Who has contraindications is a clinical judgement.
Not a training aid: the statement is about symptoms and bone. A woman asking about hormone therapy for performance or to keep muscle can be told that the menopause statement does not address it and that randomised trials found no lean-mass difference (REF-1407, A-, low certainty); the training levers are resistance training, which raised strength whatever the menopause status (REF-523, B+), and, for bone, heavy lifting with impact (REF-1405).
Symptoms that stop training are worth a clinician visit: in endurance athletes aged 40-60, sleep problems, exhaustion, joint and muscle pain and weight gain hurt training most (REF-731, B, survey); this statement says effective treatment exists for vasomotor and genitourinary symptoms. Not from this paper; the base's own practice: name the pattern, adjust the week, refer the symptoms.
What it is good for as a source: the clinical frame of hormone therapy for menopausal symptoms and bone, from the leading North American menopause society, so the assistant refers accurately. What it does not show: anything about athletes, training, muscle or performance; the grade of each position; individual risk.

Limitations

Read from the abstract only. The grades of individual recommendations, the evidence cited, panel membership, conflicts of interest and the method of literature review could not be checked.
A consensus of a professional society. Positions rest on the panel's assessment of trials and observational studies not named in the abstract; the board approved them. Other national bodies may word some positions differently (not checked here).
Who. Menopausal women in general clinical care; nothing in the abstract on athletes, heavy training, low energy availability or exercise-related questions.
Thresholds are framing. The under-60 / within-10-years line describes where the panel judges the benefit-risk ratio favourable or less favourable; it is not a rule for an individual and the abstract does not present it as one.
Funding and interests: not available from the abstract or the PubMed record; Crossref lists no funder.
How this entry was checked and changed
Why this level

(from the abstract) — a major professional-society position statement, which the rubric places at A; not A+ because the abstract does not say the panel's review was systematic, and its recommendation grades and evidence ratings, which the abstract says were assigned, are in the full text, which could not be read (closed access; the publisher page returned a Cloudflare check)