Clinical Practice Guideline

Treatment of the Symptoms of Menopause Guideline Resources

November 19, 2015

Full Guideline: Treatment of the Symptoms of the Menopause
JCEM | November 2015

Cynthia A. Stuenkel (chair), Susan R. Davis, Anne Gompel, Mary Ann Lumsden, M. Hassan Murad, JoAnn V. Pinkerton, and Richard J. Santen

The 2015 guideline addresses:

  • General evaluation and health considerations for menopausal women
  • Evaluating hormone replacement options and associated risks
  • Monitoring patients during hormone therapies
  • Treating genitourinary syndrome


Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline | ENDO 2015



Essential Points

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

  • Transdermal estrogen therapy by patch, gel or spray is recommended for women who request menopausal hormone therapy and have an increased risk of venous thromboembolism7mdash;a disease that includes deep vein thrombosis.
  • 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 called 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.

Summary of Recommendations

+ 1.0 Diagnosis and symptoms of menopause

+ 2.0 Health considerations for all menopausal women

+ 3.0 Hormone therapy for menopausal symptom relief

+ 4.0 Nonhormonal therapies for VMS

+ 5.0 Treatment of genitourinary syndrome of menopause

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