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
...agnosis
Diagnosis and Symptoms o...
...rine Society (ES) suggests diagnosing me...
...ishing a diagnosis of menopause is necessary for...
...lth Considerations for All Menopausal Wome...
...women present during the menopausal tra...
...nitions of Spectrum of Menopause Having trouble v...
...onditions That May Cause or Mimic Vasomotor Ev...
...nitourinary Syndrome of MenopauseHaving troubl...
Treatment
...eatment...
...aluating Cardiovascular Disease (CVD) Risk...
Table 5. Breast Cancer Risk Cutoffs...
...one Therapy for Menopausal Symptom Reli...
...and Progestogen Therapy...
...nopausal women...
...ardiovascular R...
...or women...
...omen at high risk of CVD, ES suggests initia...
...ith moderate risk of CVD, ES suggests transd...
...Thromboembolic Events...
...t increased risk of venous thromboem...
...n with a uterus, ES recommends a progestogen (for...
...ast Cancer
...ering MHT for menopausal symptom relief, ES sugges...
...high or intermediate risk of breas...
Tailoring MHT
...sts a shared decision-making approach...
...tom-Compounded Hormones...
...sing MHT preparations approved by the...
...njugated Equine Estrogens with B...
...postmenopausal women with a uterus and w...
...bolone...
...women with bothersome VMS and climacter...
...ainst adding tibolone to other forms o...
...against using tibolone in women with a history of...
Clinical Management of Patients Taking Hormone Therapies
...ement of Patients Taking Hormone Therapies...
...nitoring During Therapy
...or women with persistent unscheduled bleedi...
...forming women about the possible increased r...
...ts that the decision to continue MHT be revisited...
...oung women with primary ovarian insufficiency (POI...
...topping Considera...
...omen preparing to discontinue MHT, ES sugge...
...l Caveats During Treatment With MHT Havin...
...nhormonal Therapies for V...
...stmenopausal women with mild or les...
...onal Prescription Therapies for...
...seeking pharmacological management for mode...
...se women seeking relief of moderate to severe VMS...
...Counter and Alternative Nonhormonal Therapie...
...omen seeking relief of VMS with over-the...
...rnative Therapies for Treatment of VMSHaving tro...
Treatment of Genitourinary Syndrome of Menopause
...t of Genitourinary Syndrome of Menopause
...oisturizers and Lubricants
...sal women with symptoms of vulvovaginal atrophy...
...en who do not produce sufficient vagina...
...ginal Estrogen The...
...out a history of hormone- (estrogen) dependent...
...o present with symptomatic GSM (including VVA) wit...
For women taking raloxifene, witho...
...sing low-dose vaginal ET, ES suggests against...
...women using vaginal ET who report postmenopau...
...fication of Government-Approved Vaginal Est...
...emifene
...of moderate to severe dyspareunia...
...history of breast cancer presenting with dyspar...
...1. Approach to the Patient with VMS...
...fic Cautions to Use of Systemic MHT or Selectiv...
Table 10. Commonly Prescribed Hormone...