Hormone therapy is the most effective treatment for vasomotor symptoms (VMS) and other menopausal symptoms. Changing estrogen levels during menopause may impact multiple components involved in maintaining temperature homeostasis.

Health care professionals should individualize therapy based on clinical factors and patient preference. They should screen women before initiating Menopausal hormone therapy (MHT) for cardiovascular and breast cancer risk and recommend the most appropriate therapy depending on risk/benefit considerations.

Summary of Recommendations

1.0 Diagnosis of menopause

Endocrine Society suggests diagnosing menopause based on the clinical criteria of the menstrual cycle.

If establishing a diagnosis of menopause is necessary for patient management in women having undergone a hysterectomy without bilateral oophorectomy or presenting with a menstrual history that is inadequate to ascertain menopausal status -

Endocrine Society suggests making a presumptive diagnosis of menopause based on the presence of vasomotor symptoms (VMS) and, when indicated, laboratory testing that includes replicate measures of FSH and serum estradiol.

2.0 Health considerations for all menopausal women

When women present during the menopausal transition -

Endocrine Society suggests using this opportunity to address bone health, smoking cessation, alcohol use, cardiovascular risk assessment and management, and cancer screening and prevention.

3.0 Hormone therapy for menopausal symptom relief

·        Estrogen and progestogen therapy

For menopausal women < 60 years of age or < 10 years past menopause with bothersome VMS (with or without additional climacteric symptoms) who do not have contraindications or excess cardiovascular or breast cancer risks and are willing to take menopausal hormone therapy (MHT),

Endocrine Society suggests initiating estrogen therapy (ET) for those without a uterus and estrogen plus progestogen therapy (EPT) for those with a uterus.

·        Conjugated equine estrogens with bazedoxifene

For symptomatic postmenopausal women with a uterus and without contraindications, Endocrine Society suggest the combination of conjugated equine estrogens (CEE)/bazedoxifene (BZA) as an option for relief of VMS and prevention of bone loss.

·        Tibolone

For women with bothersome VMS and climacteric symptoms and without contraindications, Endocrine Society suggest tibolone (in countries where available) as an alternative to MHT.

Endocrine Society recommend against using tibolone in women with a history of breast cancer.

4.0 Nonhormonal therapies for VMS

For postmenopausal women with mild or less bothersome hot flashes -

Endocrine Society suggests a series of steps that do not involve medication, such as turning down the thermostat, dressing in layers, avoiding alcohol and spicy foods, and reducing obesity and stress.

·        Nonhormonal prescription therapies for VMS

For women seeking pharmacological management for moderate to severe VMS for whom MHT is contraindicated, or who choose not to take MHT-

Endocrine society recommends selective serotonin reuptake inhibitors (SSRIs)/serotonin-norepinephrine reuptake inhibitors (SNRIs) or gabapentin or pregabalin (if there are no contraindications).

For those women seeking relief of moderate to severe VMS who are not responding to or tolerating the nonhormonal prescription therapies, SSRIs/SNRIs or gabapentin or pregabalin, we suggest a trial of clonidine (if there are no contraindications).

5.0 Treatment of genitourinary syndrome of menopause

·        Vaginal moisturizers and lubricants

·        Vaginal estrogen therapies

GLOSSARY

VMS= Vasomotor symptoms

MHT= Menopausal hormone therapy

SSRIs= Selective serotonin reuptake inhibitors

SNRIs= Serotonin-norepinephrine reuptake inhibitors 

Doctors Liked to Read More