National consensus on the management of patients in menopause

Тобі де Вільєрс, Т. Ф Татарчук, Н. В. Авраменко, О. В. Булавенко, В. А. Габаль, О. В. Бурлака, І. Ю. Ганжий, Н. І. Геник, О. В. Грищенко, А. М. Громова, І. Ю. Головач, І. Д. Гюльмамедова, З. М. Дубоссарська, Ю. О. Дубоссарська, Г. О. Ісламова, Г. С. Ісаєва, О. О. Єфименко, В. П. Квашенко, Н. В. Косей, С. В. Неспрядько, І. П. Мазур, В. Г. Марічереда, Л. Б. Маркін, Є. І. Мітченко, Н. Ю. Педаченко, А. І. Попович, Н. М. Рожковська, В. С. Свінцицький, Г. Б. Семенина, І. І. Смоланка, Т. М. Тутченко

Abstract


This document provides an overview of existing diagnosis and treatment methods of menopausal disorders in women, proposed algorithms for diagnosis and treatment of this disease to prevent heart diseases, osteoporosis and improve the quality of ukrainian women life.

Climacteric is a physiological transition period in a woman’s life during which the reproductive system involutive processes against the age-related changes are dominated in the body, and characterized by reduction of menstrual and generative function due to genetically programmed cessation of ovarian function.

There are 4 periods of menopause: menopausal transition period, menopause, perimenopause and menopause.

No need for hormonal laboratory research to diagnosis of perimenopause and menopause for most healthy women aged over 45 with the following features: vasomotor symptoms on a background of irregular menstruation in perimenopause; absence of menstruation for the last 12 months or appearance of menopausal symptoms after hysterectomy at menopause.

The most common symptoms of menopause are vasomotor symptoms (hot flashes, night sweats, palpitations, labile blood pressure); psychological (emotional lability, depression, anxiety, irritability, sleep disturbances, poor memory and concentration); general physical symptoms (asthenia, headache, pain in muscles and joints, skin discomfort); urogenital and sexual (vaginal itching, burning, dryness and dyspareunia, frequent and urgent urination, decreased libido).

The only pathogenetically effective method for the correction of menopausal disorders is menopausal hormone therapy. For this therapy are used natural estrogen (17β-estradiol, estradiol valerate, estriol) in combination with progestins (dydrogesterone) or androgens. It is possible parenteral (injections), transdermal, vaginal and oral hormone introduction.

To correct the climacteric syndrome, urogenital disorders are used short courses of menopausal hormone therapy (for 1–5 years). For the prevention and treatment of osteoporosis menopausal hormone therapy lasts over 3 years if necessary, in combination with a bisphosphonate.


Keywords


consensus; Association of Gynecologists-Endocrinologists of Ukraine; climacteric; menopause; perimenopause; postmenopausal period; menopausal hormone therapy

References


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GOST Style Citations


1. The North American Menopause Society position statement. “Management of osteoporosis in postmenopausal women: 2010 position statement of The North American Menopause Society.” Menopause 17 (2010): 25–54.

2. de Villiers, T.J., Pines, A., Panay, N., et al. “Updated 2013 International Menopause Society recommendations on menopausal hormone therapy and preventive strategies for midlife health.” Climacteric 16 (2013):316–37.

3. Santen, R.J., Allred, D.C., Ardoin, S.P., et al. “Postmenopausal hormone therapy: An Endocrine Society Scientific Statement.” J Clin Endocrinol Metab 95.7.1 (2010): 1–66.

4. Wierman, M.E., Basson, R., Davis, S.R., et al. “Androgen therapy in women: an Endocrine Society clinical practice guideline.” J Clin Endocrinol Metab 91 (2006): 3697–710.

5. National Institutes of Health. “National Institutes of Health State-of-the-Science Conference Statement: management of menopause-related symptoms.” Ann Intern Med 142 (2005): 1003–13.

6. Bell, R.J., Lijovic, M., Fradkin, P., Davis, S.R. “A pragmatic approach to the classification of menopausal status for community-based research.” Menopause 15 (2008): 978–83.

7. 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.

8. Qiu, C., Chen, H., Wen, J., et al. “Associations between age at menarche and menopause with cardiovascular disease, diabetes, and osteoporosis in Chinese women.” J Clin Endocrinol Metab 98 (2013): 1612–21.

9. Castelo-Branco, C., Blumel, J.E., Chedraui, P., et al. “Age at menopause in Latin America.” Menopause 13 (2006): 706–12.

10. 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): 1159–68.

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12. Davison, S.L., Bell, R., Donath, S., et al. “Androgen levels in adult females: changes with age, menopause, and oophorectomy.” J Clin Endocrinol Metab 90 (2005): 3847–53.

13. Burger, H.G., Dudley, E.C., Cui, J., et al. “A prospective longitudinal study of serum testosterone, dehydroepiandrosterone sulfate, and sex hormone-binding globulin levels through the menopause transition.” J Clin Endocrinol Metab 85 (2000): 2832–8.

14. Judd, H.L., Lucas, W.E., Yen, S.S. “Effect of oophorectomy on circulating testosterone and androstenedione levels in patients with endometrial cancer.” Am J Obstet Gynecol 118 (1974): 793–8.

15. van der Stege, J.G., Groen, H., van Zadelhoff, S.J., et al. “Decreased androgen concentrations and diminished general and sexual wellbeing in women with premature ovarian failure.” Menopause 15 (2008): 23–31.

16. Kalantaridou, S.N., Calis, K.A., Vanderhoof, V.H., et al. “Testosterone deficiency in young women with 46, XX spontaneous premature ovarian failure.” Fertil Steril 86 (2006): 1475–82.

17. Van Look, P.F., Lothian, H., Hunter, W.M., et al. “Hypothalamic-pituitary-ovarian function in perimenopausal women.” Clin Endocrinol 7 (1977): 13–31.

18. Gold, E.B., Colvin, A., Avis, N., et al. “Longitudinal analysis of the association between vasomotor symptoms and race/ethnicity across the menopausal transition: Study of Women’s Health Across the Nation.” Am J Public Health 96 (2006): 1226–35.

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20. Avis, N.E., Brockwell, S., Randolph, J.F. Jr, et al. “Longitudinal changes in sexual functioning as women transition through menopause: results from the Study of Women’s Health Across the Nation.” Menopause 16 (2009): 442–52.

21. Chuni, N., Sreeramareddy, C.T. “Frequency of symptoms, determinants of severe symptoms, validity of and cut-off score for Menopause Rating Scale (MRS) as a screening tool: a cross-sectional survey among midlife Nepalese women.” BMC Women’s Health 11 (2011): 30.

22. Olaolorun, F.M., Lawoyin, T.O. “Experience of menopausal symptoms by women in an urban community in Ibadan, Nigeria.” Menopause 16 (2009): 822–30.

23. Waidyasekera, H., Wijewardena, K., Lindmark, G., Naessen, T. “Menopausal symptoms and quality of life during the menopausal transition in Sri Lankan women.” Menopause 16 (2009): 164–70.

24. Blumel, J.E., Chedraui, P., Baron, G., et al. “A large multinational study of vasomotor symptom prevalence, duration, and impact on quality of life in middle-aged women.” Menopause 18 (2011): 778–85.

25. Vikstrom, J., Spetz Holm, A.C., Sydsjo, G., et al. “Hot flushes still occur in a population of 85-year-old Swedish women.” Climacteric 16 (2013): 453–9.

26. Kroenke, C.H., Caan, B.J., Stefanick, M.L., et al. “Effects of a dietary intervention and weight change on vasomotor symptoms in the Women’s Health Initiative.” Menopause 19 (2012): 980–8.

27. Elavsky, S., Gonzales, J.U., Proctor, D.N., et al. “Effects of physical activity on vasomotor symptoms: examination using objective and subjective measures.” Menopause 19 (2012): 1095–103.

28. de Villiers, T.J., Gass, M.L., Haines, C.J., et al. “Global Consensus Statement on menopausal hormone therapy.” Climacteric 16 (2013): 203–4.

29. The North American Menopause Society. “Estrogen and progestogen use in peri- and postmenopausal women: March 2007 position statement of The North American Menopause Society.” Menopause 14 (2007): 168–82.

30. Chrisman, C., Ribeiro, P., Dalton, V.K. “The levonorgestrel-releasing intrauterine system: an updated review of the contraceptive and noncontraceptive uses.” Clin Obstet Gynecol 50 (2007): 886–97.

31. Simon, J.A. “What if the Women’s Health Initiative had used transdermal estradiol and oral progesterone instead?” Menopause 21 (2014):769–83.

32. Fournier, A., Fabre, A., Mesrine, S., et al. “Use of different postmenopausal hormone therapies and risk of histology- and hormone receptor-defined invasive breast cancer.” J Clin Oncol 26 (2008): 1260–8.

33. Leonetti, H., Longo, S., Anasti, J. “Transdermal progesterone cream for vasomotor symptoms and postmenopausal bone loss.” Obstet Gynecol 94 (1999): 225–8.

34. Leonetti, H.B., Wilson, K.J., Anasti, J.N. “Topical progesterone cream has an antiproliferative effect on estrogen stimulated endometrium.” Fertil Steril 79 (2003): 221–2.

35. Cooper, A., Spencer, M.I., Whitehead, M., et al. “Systemic absorption of progesterone from Progest cream in postmenopausal women.” Lancet 351 (1998): 1255.

36. Birkhauser, M.H., Panay, N., Archer, D.F., et al. “Updated practical recommendations for hormone replacement therapy in the peri- and postmenopause.” Climacteric 11 (2008): 108–23.

37. Nijland, E.A., Weijmar Schultz, W.C., Nathorst-Boos, J., et al. “Tibolone and transdermal E2/NETA for the treatment of female sexual dysfunction in naturally menopausal women: results of a randomized active-controlled trial.” J Sex Med 5 (2008): 646–56.

38. Cummings, S.R., Ettinger, B., Delmas, P.D., et al. “The effects of tibolone in older postmenopausal women.” N Engl J Med 359 (2008): 697–708.

39. Pinkerton, J.V., Abraham, L., Bushmakin, A.G., et al. “Evaluation of the efficacy and safety of bazedoxifene/ conjugated estrogens for secondary outcomes including vasomotor symptoms in postmenopausal women by years since menopause in the Selective Estrogens, Menopause and Response to Therapy (SMART) Trials.” J Womens Health (Larchmt) 23 (2014): 18–28.

40. Mirkin, S., Komm, B.S., Pan, K., Chines, A.A. “Effects of bazedoxifene/conjugated estrogens on endometrial safety and bone in postmenopausal women.” Climacteric 16 (2013): 338–46.

41. de Villiers, T.J., Chines, A.A., Palacios, S., et al. “Safety and tolerability of bazedoxifene in postmenopausal women with osteoporosis: results of a 5-year, randomized, placebo-controlled phase 3 trial.” Osteoporos Int 22 (2011): 567–76.

42. Pinkerton, J.V., Komm, B.S., Mirkin, S. “Tissue selective estrogen complex combinations with bazedoxifene/conjugated estrogens as a model.” Climacteric 16 (2013): 618–28.

43. Portman, D.J., Bachmann, G.A., Simon, J.A. “Ospemifene, a novel selective estrogen receptor modulator for treating dyspareunia associated with postmenopausal vulvar and vaginal atrophy.” Menopause 20 (2013): 623–30.

44. Simon, J., Portman, D., Mabey, R.G. Jr. “Long-term safety of ospemifene (52-week extension) in the treatment of vulvar and vaginal atrophy in hysterectomized postmenopausal women.” Maturitas 77 (2014): 274–81.

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DOI: http://dx.doi.org/10.18370/2309-4117.2016.27.8-25

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