Continuing Use of Systemic Hormone Therapy for Women Aged 65 Years and Older

By: Red Hot Mamas

Published: June 2, 2015

The North American Menopause Society (NAMS) announces the June 2, 2015, online publication of its statement, “The North American Menopause Society Statement on Continuing Use of Systemic Hormone Therapy After Age 65,” and the accompanying editorial, “NAMS Supports Judicious Use of Systemic Hormone Therapy for Women Aged 65 Years and Older.” The statement and editorial will appear in the July 2015 issue of Menopause.

Brought up by members as a Town Hall topic at the 2013 Annual Meeting was the Beers list, a list of medications deemed to have more adverse effects in older adults (≥ 65 y) than in younger adults. The list is named after Mark Beers, MD, a geriatrician and the editor of The Merck Manual of Geriatrics. The list is designed to help clinicians avoid riskier medications in older adults.

A challenge identified by members and other clinicians is the inclusion on the list of systemic hormone therapy (HT) for adults aged older than 65 years. Although the list is not to be used in a punitive manner, it has been included in many quality-of-care measures that may be used to evaluate clinician performance and the performance of healthcare systems. Despite efforts by NAMS and the American Congress of Obstetricians and Gynecologists for reconsideration to have it removed, HT remains on the Beers list.

In response to the continuing inclusion of systemic HT on the Beers list, NAMS states

HT is the most effective treatment for symptoms of menopause
Vasomotor symptoms may persist for more than a decade in many women and may continue in women after the age of 65, and these symptoms can disrupt sleep and otherwise adversely affect health and quality of life
Provided a woman has been advised of increased risks associated with continuing HT beyond age 60 and she has appropriate medical supervision, extending use of HT with the lowest effective dose is acceptable under some circumstances in women older than 65
Use of HT should be individualized and not discontinued based solely on a woman’s age
Because of the lack of alternative treatments that are not on the Beers list, exceptions should be made in terms of quality-of-care metrics for menopausal women, or at the very least HT should be placed in the “use with caution” category.