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

...agnosis...

...is and Symptoms of Menopause...

...rine Society (ES) suggests diagnosing men...

...ablishing a diagnosis of menopause is necess...


...lth Considerations for All Menopausal Wo...

...hen women present during the menopau...

...Definitions of Spectrum of MenopauseÂ...

...ditions That May Cause or Mimic Vasomotor Events...

...ble 3. Genitourinary Syndrome of MenopauseHaving...


Treatment

Treatm...

...luating Cardiovascular Disease (CVD)...


...le 5. Breast Cancer Risk Cutoffs for Counseli...


...herapy for Menopausal Symptom Relief...

...n and Progestogen Ther...

...r menopausal wome...

...rdiovascular Ris...

...r women

...igh risk of CVD, ES suggests initiating nonhorm...

...moderate risk of CVD, ES suggests transde...

...s Thromboembolic Events

...increased risk of venous thromboemboli...

...th a uterus, ES recommends a progesto...

...reast Cance...

...or women considering MHT for menopa...

...r women at high or intermediate risk of breast c...


...oring MHT...

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


...m-Compounded Hormones

...mends using MHT preparations approved b...


...quine Estrogens with Bazedoxifene...

...ptomatic postmenopausal women with a ut...


...ibolon...

For women with bothersome VMS and climacteric...

...ds against adding tibolone to other...

...commends against using tibolone in women with a hi...


Clinical Management of Patients Taking Hormone Therapies

Clinical Management of Patients Taking Hormon...

...ring During Therapy...

...omen with persistent unscheduled bleeding whil...

...recommends informing women about the poss...

...t the decision to continue MHT be rev...

...g women with primary ovarian insufficiency (P...


...ng Considerations...

For women preparing to discontinue MHT, ES...


...nical Caveats During Treatment With MHT Having...


...hormonal Therapies f...

...postmenopausal women with mild or less bother...


...onhormonal Prescription Ther...

...eking pharmacological management for moderate...

...those women seeking relief of moder...


...r-the-Counter and Alternative Nonhormon...

...g relief of VMS with over-the-counter (OTC) or...


Table 7. Alternative Therapies for...


Treatment of Genitourinary Syndrome of Menopause

...eatment of Genitourinary Syndrome of Me...

...al Moisturizers and Lubrica...

...r postmenopausal women with symptoms of vul...

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


...l Estrogen Therapies...

...without a history of hormone- (estrogen) depende...

...resent with symptomatic GSM (including VVA) with...

...taking raloxifene, without a history of ho...

...women using low-dose vaginal ET, ES s...

...women using vaginal ET who report postmenopa...


...ble 8. Classification of Government-Approved...


...pemifene...

...ment of moderate to severe dyspareunia associat...

...men with a history of breast cancer pr...


.... Approach to the Patient with VMS Co...


...fic Cautions to Use of Systemic MHT or Selecti...


...10. Commonly Prescribed Hormone Thera...