Menopause
Key Points
Key Points
Benefits may exceed risks for the majority of symptomatic postmenopausal women who are under age 60 or less than 10 years since the onset of menopause.
Health care professionals should individualize therapy based on clinical factors and patient preference.
Before initiating MHT, clinicians should screen women 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.
Diagnosis
...Diagnosis...
Diag...
...e Society (ES) suggests diagnosing menopause...
...f establishing a diagnosis of menopause is...
Healt...
...hen women present during the menopausal tra...
...Definitions of Spectrum of Menopause Havi...
Table 2. Conditions That May Cause or Mi...
...ourinary Syndrome of MenopauseHaving trouble...
Treatment
...Treatment...
...ating Cardiovascular Disease (CVD) Risk in Women...
...ast Cancer Risk Cutoffs for Counseling Bef...
...Hormone Therap...
...Estrogen and...
...or menopausal women...
...Cardiovascu...
...r women...
...at high risk of CVD, ES suggests initiating...
...th moderate risk of CVD, ES suggests transder...
...Venous Thr...
For women at increased risk of venous throm...
...a uterus, ES recommends a progestogen (for exa...
...Breast Cancer...
...sidering MHT for menopausal symptom relie...
...en at high or intermediate risk of breas...
...Tailoring MH...
...ests a shared decision-making appro...
...Custom-Compounded Horm...
...recommends using MHT preparations approved by t...
...Conjugated...
...symptomatic postmenopausal women with a uteru...
...Tibol...
...or women with bothersome VMS and climac...
...ommends against adding tibolone to othe...
...commends against using tibolone in women wit...
Clinical Management of Patients Taking Hormone Therapies
...Clinical Management of Pat...
...Monitoring Dur...
...ersistent unscheduled bleeding while taking M...
...S recommends informing women about the possible...
...ests that the decision to continue MHT...
...women with primary ovarian insufficiency (POI),...
...Stopping Consideratio...
...en preparing to discontinue MHT, ES suggests a...
...Clinical Caveats During Treatment Wi...
...Nonho...
...postmenopausal women with mild or...
...Nonhormo...
...omen seeking pharmacological management for mode...
...en seeking relief of moderate to severe VMS who...
...Over-the-Co...
...ng relief of VMS with over-the-counter (OTC) o...
...7. Alternative Therapies for Treatment...
Treatment of Genitourinary Syndrome of Menopause
...T...
...Vaginal Moisturiz...
...postmenopausal women with symptoms of vulvovaginal...
For women who do not produce suffici...
...Vaginal...
...out a history of hormone- (estrogen) depe...
...o present with symptomatic GSM (including VVA)...
...women taking raloxifene, without a...
...women using low-dose vaginal ET, ES suggests agai...
...ng vaginal ET who report postmenopausal bleeding...
...8. Classification of Government-Approved Va...
...O...
...moderate to severe dyspareunia associated with...
...h a history of breast cancer presenting with...
...oach to the Patient with VMS Contemplating MHT...
...ific Cautions to Use of Systemic MHT or Sel...
...monly Prescribed Hormone TherapiesH...