Treatment of symptoms of the menopause. Еndocrine society clinical practice guideline

Cynthia A. Stuenkel, Susan R. Davis, Anne Gompel, Mary Ann Lumsden, M. Hassan Murad, JoAnn V. Pinkerton, Richard J. Santen

Abstract


The objective of this document is to generate a practice guideline for the management and treatment of symptoms of the menopause.

The Treatment of Symptoms of the Menopause Task Force included six experts, a methodologist, and a medical writer, all appointed by The Endocrine Society.

The Task Force developed this evidenced-based guideline using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe the strength of recommendations and the quality of evidence. The Task Force commissioned three systematic reviews of published data and considered several other existing meta-analyses and trials.

Multiple e-mail communications, conference calls, and one face-to-face meeting determined consensus. Committees of The Endocrine Society, representatives from endorsing societies, and members of The Endocrine Society reviewed and commented on the drafts of the guidelines. The Australasian Menopause Society, the British Menopause Society, European Menopause and Andropause Society, the European Society of Endocrinology, and the International Menopause Society (co-sponsors of the guideline) reviewed and commented on the draft.

Conclusions: menopausal hormone therapy (MHT) is the most effective treatment for vasomotor symptoms and other symptoms of the climacteric. Benefits may exceed risks for the majority of symptomatic postmenopausal women who are under age 60 or under 10 years since the onset of menopause. Health care professionals should individualize therapy based on clinical factors and patient preference. They should screen women before initiating MHT for cardiovascular and breast cancer risk and recommend the most appropriate therapy depending on risk/benefit considerations. Current evidence does not justify the use of MHT to prevent coronary heart disease, breast cancer, or dementia.

Other options are available for those with vasomotor symptoms who prefer not to use MHT or who have contraindications because these patients should not use MHT. Low-dose vaginal estrogen and ospemifene provide effective therapy for the genitourinary syndrome of menopause, and vaginal moisturizers and lubricants are available for those not choosing hormonal therapy. All postmenopausal women should embrace appropriate lifestyle measures.


Keywords


menopause; clinical guideline; US Endocrine Society

References


Singh, M. “Early age of natural menopause in India, a biological marker for early preventive health programs.” Climacteric, 15(2012): 581–586.

Ang, S.B., How, C.H. “Menopause: an important milestone in women’s health.” Singapore Med J, 54(2013): 60–63.

Gold, E.B., Crawford, S.L., Avis, N.E., et al. “Factors related to age at natural menopause: longitudinal analyses from SWAN.” Am J Epidemiol, 178(2013): 70–83.

Harlow, S.D., Gass, M., Hall, J.E., et al. “Executive summary of the Stages of Reproductive Aging Workshop_10: addressing the unfinished agenda of staging reproductive aging.” J Clin Endocrinol Metab, 97(2012):1159–1168.

Hale, G.E., Robertson, D.M., Burger, H.G. “The perimenopausal woman: endocrinology and management.” J Steroid Biochem Mol Biol, 142(2014): 121–131.

Nelson, L.M. “Clinical practice. Primary ovarian insufficiency.” N Engl J Med, 360(2009): 606–614.

Kalantaridou, S.N., Davis, S.R., Nelson, L.M. “Premature ovarian failure.” Endocrinol Metab Clin North Am, 27(1998): 989–1006.

Portman, D.J., Gass, M.L., Vulvovaginal Atrophy Terminology Consensus Conference Panel. “Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society.” Menopause, 21(2014): 1063–1068.

Santen, R.J., Allred, D.C., Ardoin, S.P., et al. “Postmenopausal hormone therapy: an Endocrine Society scientific statement.” J Clin Endocrinol Metab, 95(2010): 1–66.

Weiss, N.S., Szekely, D.R., Austin, D.F. “Increasing incidence of endometrial cancer in the United States.” N Engl J Med, 294(1976):1259–1262.

Mack, T.M., Pike, M.C., Henderson, B.E., et al. “Estrogens and endometrial cancer in a retirement community.” N Engl J Med, 294(1976): 1262–1267.

Rossouw, J.E., Anderson, G.L., Prentice, R.L., et al. “Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial.” JAMA, 288(2002): 321–333.

Manson, J.E., Chlebowski, R.T., Stefanick, M.L., et al. “Menopausal hormone therapy and health outcomes during the intervention and extended post stopping phases of the Women’s Health Initiative randomized trials.” JAMA, 310(2013):1353–1368.

The Writing Group for the PEPI Trial. “Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women. The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial.” JAMA, 273(1995): 199–208.

Manson, J.E. “Current recommendations: what is the clinician to do?” Fertil Steril, 101(2014): 916–921.

Goff, D.C. Jr, Lloyd-Jones, D.M., Bennett, G., et al. “2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.” Circulation, 129(2014):49–73.

Arafah, B.M. “Increased need for thyroxine in women with hypothyroidism during estrogen therapy.” N Engl J Med, 344(2001): 1743–1749.

Santen, R.J. “Vaginal administration of estradiol: effects of dose, preparation and timing on plasma estradiol levels.” Climacteric, 18(2015): 121–134.


GOST Style Citations


1. Singh, M. “Early age of natural menopause in India, a biological marker for early preventive health programs.” Climacteric, 15(2012): 581–586.

2. Ang, S.B., How, C.H. “Menopause: an important milestone in women’s health.” Singapore Med J, 54(2013): 60–63.

3. Gold, E.B., Crawford, S.L., Avis, N.E., et al. “Factors related to age at natural menopause: longitudinal analyses from SWAN.” Am J Epidemiol, 178(2013): 70–83.

4. Harlow, S.D., Gass, M., Hall, J.E., et al. “Executive summary of the Stages of Reproductive Aging Workshop_10: addressing the unfinished agenda of staging reproductive aging.” J Clin Endocrinol Metab, 97(2012):1159–1168.

5. Hale, G.E., Robertson, D.M., Burger, H.G. “The perimenopausal woman: endocrinology and management.” J Steroid Biochem Mol Biol, 142(2014): 121–131.

6. Nelson, L.M. “Clinical practice. Primary ovarian insufficiency.” N Engl J Med, 360(2009): 606–614.

7. Kalantaridou, S.N., Davis, S.R., Nelson, L.M. “Premature ovarian failure.” Endocrinol Metab Clin North Am, 27(1998): 989–1006.

8. Portman, D.J., Gass, M.L., Vulvovaginal Atrophy Terminology Consensus Conference Panel. “Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society.” Menopause, 21(2014): 1063–1068.

9. Santen, R.J., Allred, D.C., Ardoin, S.P., et al. “Postmenopausal hormone therapy: an Endocrine Society scientific statement.” J Clin Endocrinol Metab, 95(2010): 1–66.

10. Weiss, N.S., Szekely, D.R., Austin, D.F. “Increasing incidence of endometrial cancer in the United States.” N Engl J Med, 294(1976):1259–1262.

11. Mack, T.M., Pike, M.C., Henderson, B.E., et al. “Estrogens and endometrial cancer in a retirement community.” N Engl J Med, 294(1976): 1262–1267.

12. Rossouw, J.E., Anderson, G.L., Prentice, R.L., et al. “Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial.” JAMA, 288(2002): 321–333.

13. Manson, J.E., Chlebowski, R.T., Stefanick, M.L., et al. “Menopausal hormone therapy and health outcomes during the intervention and extended post stopping phases of the Women’s Health Initiative randomized trials.” JAMA, 310(2013):1353–1368.

14. The Writing Group for the PEPI Trial. “Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women. The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial.” JAMA, 273(1995): 199–208.

15. Manson, J.E. “Current recommendations: what is the clinician to do?” Fertil Steril, 101(2014): 916–921.

16. Goff, D.C. Jr, Lloyd-Jones, D.M., Bennett, G., et al. “2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.” Circulation, 129(2014):49–73.

17. Arafah, B.M. “Increased need for thyroxine in women with hypothyroidism during estrogen therapy.” N Engl J Med, 344(2001): 1743–1749.

18. Santen, R.J. “Vaginal administration of estradiol: effects of dose, preparation and timing on plasma estradiol levels.” Climacteric, 18(2015): 121–134.





DOI: http://dx.doi.org/10.18370/2309-4117.2015.26.86-93

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ISSN 2411-1295 (Online), ISSN 2309-4117 (Print)