Menopause

Publication Date: November 1, 2015

Key Points

Key Points

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 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

...Diagnos...

...Dia...

...ociety (ES) suggests diagnosing menopa...

...g a diagnosis of menopause is necess...


...Health Consideration...

...present during the menopausal transition,...

...Definitions of Spectrum of Menopause ...

...2. Conditions That May Cause or Mimic Vasomotor...

Table 3. Genitourinary Syndrome of Menopaus...


Treatment

...Treatme...

...ble 4. Evaluating Cardiovascular Diseas...


...Breast Cancer Risk Cutoffs for Counseling Be...


...Ho...

...Estro...

...nopausal women...

...Cardiov...

...or women...

...women at high risk of CVD, ES suggests initi...

...with moderate risk of CVD, ES suggests tr...

...Ven...

...en at increased risk of venous thromb...

...with a uterus, ES recommends a progestogen...

...Breast Cancer...

...or women considering MHT for menopausal symp...

...gh or intermediate risk of breast cancer cons...


...T...

...shared decision-making approach to decide...


...s using MHT preparations approved by the U...


...Conjugated Equine Es...

For symptomatic postmenopausal women with a ute...


...Tibolone...

...or women with bothersome VMS and c...

...mmends against adding tibolone to ot...

...against using tibolone in women wit...


Clinical Management of Patients Taking Hormone Therapies

...Clinical Management...

...r women with persistent unscheduled b...

...nforming women about the possible increased risk...

...s that the decision to continue MHT...

...men with primary ovarian insufficiency (POI), pre...


...Stopping Consi...

...women preparing to discontinue MHT, ES suggests...


...ble 6. Clinical Caveats During Treatment With MHT...


...Nonhormonal Thera...

...postmenopausal women with mild or less both...


...Nonhormonal P...

...women seeking pharmacological mana...

...hose women seeking relief of moderate to s...


...Over-the-Cou...

...king relief of VMS with over-the-count...


...Alternative Therapies for Treatment of...


Treatment of Genitourinary Syndrome of Menopause

...Treatme...

...Vaginal Moistu...

...menopausal women with symptoms of vulvo...

...women who do not produce sufficient vaginal...


...Vaginal Estroge...

...r women without a history of hormone-...

...esent with symptomatic GSM (including...

...women taking raloxifene, without a history of horm...

...low-dose vaginal ET, ES suggests aga...

...vaginal ET who report postmenopausal blee...


...Classification of Government-Appro...


...Ospemifene...

...nt of moderate to severe dyspareunia ass...

...th a history of breast cancer presen...


.... Approach to the Patient with VMS Contemp...


...ific Cautions to Use of Systemic MHT or Selective...


...nly Prescribed Hormone Therapies Pr...