October 7, 2015

Endocrine Society Publishes New Guideline on Treatment of Menopausal Symptoms

WASHINGTON, DC -- October 7, 2015 -- The Endocrine Society today issued a Clinical Practice Guideline (CPG) on identifying women who are candidates for treatment of menopausal symptoms and selecting the best treatment options for each individual.

The CPG was published online and will appear in the November 2015 print issue of the Journal of Clinical Endocrinology and Metabolism(JCEM).

Women now have a broader range of treatment options for menopausal symptoms than ever before, but many clinicians are reluctant to pursue them. A 2012 Endocrine Society survey found that 72% of women currently experiencing menopause symptoms had not received any treatment for them.

Hormone therapy has been under intense scrutiny since 2002, when the Women’s Health Initiative (WHI) reported that the combination of conjugated equine oestrogens and medroxyprogesterone acetate (Prempro) increased the risk for blood clots, stroke, breast cancer, and myocardial infarctions in postmenopausal women aged 50 to 79 years at study onset. However, additional research conducted in the ensuing years indicated the level of risk depends on the individual woman’s health history, age and other factors.

Experts have formed a consensus that the benefits of menopausal hormone therapy exceed the risks for most healthy women seeking relief of menopausal symptoms.

“There is no need for a woman to suffer from years of debilitating menopausal symptoms, as a number of therapies, both hormonal and non-hormonal are now available,” said Cynthia A. Stuenkel, MD, University of California at San Diego, San Diego, California. “Every woman should be full partners with her healthcare providers in choosing whether treatment is right for her and what treatment option best suits her needs. The decision should be based on available evidence regarding the treatment’s safety and effectiveness, as well as her individual risk profile and personal preferences.”

In the CPG, the Endocrine Society recommends that women with a uterus who decide to undergo menopausal hormone therapy with oestrogen and progestogen be informed about risks and benefits, including the possible increased risk of breast cancer during and after discontinuing treatment. Healthcare providers should advise all women, including those taking hormone therapy, to follow guidelines for breast cancer screening.

Other recommendations from the CPG include:

• Transdermal oestrogen therapy by patch, gel or spray is recommended for women who request menopausal hormone therapy and have an increased risk of venous thromboembolism.
• Progestogen treatment prevents uterine cancer in women taking oestrogen for hot flash relief. For women who have undergone a hysterectomy, it is not necessary.
• If a woman on menopausal hormone therapy experiences persistent unscheduled vaginal bleeding, she should be evaluated to rule out endometrial cancer or hyperplasia.
• Selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), gabapentin or pregabalin are recommended for women who want medication to manage moderate to severe hot flashes, but either prefer not to take hormone therapy or have significant risk factors that make hormone therapy inadvisable.
• Low-dose vaginal oestrogen therapy is recommended to treat women for genitourinary symptoms of menopause, such as burning and irritation of the genitalia, dryness, discomfort or pain with intercourse; and urinary urgency or recurrent infections. This treatment should only be used in women without a history of oestrogen-dependent cancers.

This CPG was co-sponsored by the Australasian Menopause Society, the British Menopause Society, the European Society of Endocrinology, and the International Menopause Society.

The full guideline can be found here: http://press.endocrine.org/doi/10.1210/jc.2015-2236

SOURCE: The Endocrine Society
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