New Clinical Practice Guideline Details Menopausal Therapy Options

New Clinical Practice Guideline Details Menopausal Therapy Options
New Clinical Practice Guideline Details Menopausal Therapy Options

A new clinical practice guideline has been issued by the Endocrine Society on the treatment of menopausal symptoms. The guideline will appear in the November 2015 issue of the Journal of Clinical Endocrinology and Metabolism.

Since 2002, after the Women's Health Initiative reported that hormone therapy, specifically a combination of conjugated equine estrogens and medroxyprogesterone acetate, increased the risk of blood clots, stroke, breast cancer, and heart attacks in postmenopausal women aged 50–79 years, treatment of menopausal symptoms has been under scrutiny. However, additional research later showed that the benefits of menopausal hormone therapy outweighed the risks for healthy women seeking relief from symptoms. In the new guideline, the Endocrine Society recommends that women with a uterus who decide to undergo menopausal hormone therapy with estrogen and progestogen should be informed of the risks and benefits, including the risk of breast cancer.

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Other recommendations reported in the guideline include:

  • Transdermal estrogen 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 estrogen 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.
  • Medications such as 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 estrogen 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 estrogen-dependent cancers.

"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, the chair of the task force that authored the guideline and an endocrinologist specializing in menopause at the University of California, San Diego. "Every woman should be full partners with her health care 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."

For more information visit Endocrine.org.

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