Treatment of Symptoms of the Menopause

Publication Date: November 1, 2015

Last Updated: July 25, 2023

Diagnosis

Diagnosis and Symptoms of Menopause

The Endocrine Society (ES) suggests diagnosing menopause based on the clinical menstrual cycle criteria. (2-L)

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If establishing a diagnosis of menopause is necessary for patient management in women having undergone a hysterectomy without bilateral oophorectomy or presenting with a menstrual history that is inadequate to ascertain menopausal status, ES suggests making a presumptive diagnosis of menopause based on the presence of vasomotor symptoms (VMS) and, when indicated, laboratory testing that includes replicate measures of follicle-stimulating hormone (FSH) and serum estradiol. ( 2-L )

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Treatment

Hormone Therapy for Menopausal Symptom Relief

Estrogen and Progestogen Therapy

For menopausal women <60 years of age or <10 years past menopause with bothersome vasomotor symptoms (VMS) (with or without additional climacteric symptoms) who do not have contraindications or excess cardiovascular or breast cancer risks and are willing to take menopausal hormone therapy (MHT), ES suggests initiating estrogen therapy (ET) for those without a uterus and estrogen plus progestogen therapy (EPT) for those with a uterus. (2-L)

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Cardiovascular Risk

For women <10 years past menopause onset considering MHT for menopausal symptom relief, ES suggests evaluating the baseline risk of cardiovascular disease (CVD) and taking this risk into consideration when advising for or against MHT and when selecting type, dose, and route of administration. ( 2-L )

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For women at high risk of CVD, ES suggests initiating nonhormonal therapies to alleviate bothersome VMS (with or without climacteric symptoms) over MHT. (2-L)

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For women with moderate risk of CVD, ES suggests transdermal estradiol as first-line treatment, alone for women without a uterus or combined with micronized progesterone (or another progestogen that does not adversely modify metabolic parameters) for women with a uterus, because these preparations have less untoward effect on blood pressure, triglycerides, and carbohydrate metabolism. (2-L)

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Venous Thromboembolic Events

For women at increased risk of venous thromboembolism (VTE) who request MHT, ES recommends a nonoral route of ET at the lowest effective dose, if not contraindicated. (1-L)

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For women with a uterus, ES recommends a progestogen (for example, progesterone and dydrogestone) that is neutral on coagulation parameters. (1-M)

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Breast Cancer

For women considering MHT for menopausal symptom relief, ES suggests evaluating the baseline risk of breast cancer and taking this risk into consideration when advising for or against MHT and when selecting type, dose, and route of administration. ( 2-L )

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For women at high or intermediate risk of breast cancer considering MHT for menopausal symptom relief, ES suggests nonhormonal therapies over MHT to alleviate bothersome VMS. (2-L)