Individualize menopause therapy based on clinical benefits and risks, states new guideline

Hormone therapy continues to be the most effective treatment for symptoms of menopause. Because there are risks as well as benefits of hormone therapy, health care professionals should individualize treatment based on clinical factors and patient preference, according to a new clinical practice guideline for the treatment of menopause symptoms, released by the Endocrine Society.

“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, 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,” Dr. Stuenkel said.

Women now have a broader range of treatment options for menopausal symptoms than ever before, but many clinicians have been reluctant to pursue them. As many as 72% of women experiencing menopause symptoms had not received any treatment, according to a 2012 survey by the Endocrine Society.

The benefits of menopausal hormone therapy exceed the risks for most healthy women who are under age 60, or under 10 years since the onset of menopause,and are seeking relief of menopausal symptoms, according to the guideline. Women who decide to undergo menopausal hormone therapy with estrogen and progestogen should be informed about the risks and benefits, including the possible increased risk of breast cancer during and after discontinuing treatment, the Endocrine Society noted. So, health care providers should advise all women, including those taking menopausal hormone therapy, to be screened for breast cancer, the guideline indicates.

Other recommendations from the guideline include:

• Transdermal estrogen therapy by patch, gel, or spray is recommended for women who request menopausal hormone therapy and who 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.
• 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.

The guideline, “Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline,” was published online October 7, 2015, and appears in the November 2015 print issue of the Journal of Clinical Endocrinology and Metabolism.

The Endocrine Society, through its public education arm the Hormone Health Network, has developed aninteractive digital resource called the Menopause Map^TM for women to explore the stages of menopause and learn about symptoms they may experience. The Hormone Health Network also offers a digital toolkit for health care providers.