In March 2007, the North American Menopause Society (NAMS) published an updated position statement on the use of hormone therapy in postmenopausal women.1 NAMS recommends hormone therapy, which is a highly effective treatment for hot flushes and vaginal atrophy,2 as first line treatment for women with moderate to severe symptoms. It is also effective for preventing osteoporotic fractures,3 4 but NAMS recommends that hormone therapy for this purpose should be weighed against potential harm and that other approved preventive treatments such as bisphosphonates should be considered. These recommendations are clear, simple, and based on solid evidence from many randomised controlled trials.

However, NAMS recommendations are less clear in several other areas. For example, after clearly stating that hormone therapy increases risk of venous thromboembolic events and stroke, no advice is provided about how clinicians and patients should use this information. Similarly, NAMS notes that risk of breast cancer …