Management of Menopausal Symptoms

Publication Date: January 1, 2014
Last Updated: March 14, 2022

Recommendations and Conclusions

The following recommendations and conclusions are based on good or consistent scientific evidence.

  • Systemic HT, with estrogen alone or in combination with progestin, is the most effective therapy for vasomotor symptoms related to menopause.
  • Low-dose and ultra-low systemic doses of estrogen are associated with a better adverse effect profile than standard doses and may reduce vasomotor symptoms in some women.
  • Given the variable response to HT and the associated risks, it is recommended that health care providers individualize care and treat women with the lowest effective dose for the shortest duration that is needed to relieve vasomotor symptoms.
  • The risks of combined systemic HT include thromboembolic disease and breast cancer.
  • Selective serotonin reuptake inhibitors, SSNRIs, clonidine, and the gabapentin are effective alternatives to HT for the treatment of vasomotor symp- toms related to menopause.
  • Estrogen therapy effectively alleviates atrophic vaginal symptoms related to menopause. Local therapy is advised for the treatment of women with only vaginal symptoms.
  • Paroxetine is the only nonhormonal therapy that is approved by the FDA for the treatment of vasomo- tor symptoms.
  • The FDA approved ospemifene for treating moderate-to-severe dyspareunia in postmenopausal women.



Management of Menopausal Symptoms

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