Experts Recommend Assessing Individual Benefits, Risks of Menopausal Therapies

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, entitled “Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline,” was published online and will appear in the November 2015 print issue of the Journal of Clinical Endocrinology and Metabolism (JCEM), a publication of the Endocrine Society.

Menopause is the life stage that takes place when a woman’s ovaries dramatically decrease production of the hormones estrogen and progesterone, and her menstrual periods stop. The average age of an American woman experiencing menopause is around 51 years old.

During menopause, many women experience symptoms such as hot flashes, night sweats, sleep disturbances, mood changes, joint pain, recurrent urinary tract infections, and difficult or painful sexual intercourse. These symptoms can start in the years before a woman’s final menstrual period and last for more than a decade.

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 percent of women currently experiencing menopause symptoms had not received any treatment for them.

Hormone therapy—at one time the most popular treatment for menopausal symptoms— has been under intense scrutiny since 2002, when a large government study called the Women’s Health Initiative (WHI) reported that hormone therapy – specifically the combination of conjugated equine estrogens and medroxyprogesterone acetate (Prempro) – increased the risk for blood clots, stroke, breast cancer and heart attacks in postmenopausal women aged 50 to 79 years at study onset. But 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, 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.”

In the CPG, 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.

Other recommendations from the CPG 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 – 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.

The Hormone Health Network, the Endocrine Society’s public education arm, developed an interactive digital resource called the Menopause Map^TM for women to explore the stages of menopause and learn about symptoms they may experience. The Menopause Map^TM related resources are available at www.menopausemap.org. The Hormone Health Network also offers a digital toolkit for health care providers.

Other members of the Endocrine Society task force that developed this CPG include: Susan R. Davis of Monash University in Melbourne, Australia; Anne Gompel of the Université Paris Descartes in Paris, France; Mary Ann Lumsden of the University of Glasgow School of Medicine in Glasgow, Scotland; M. Hassan Murad of the Mayo Clinical in Rochester, MN; JoAnn V. Pinkerton of the University of Virginia in Charlottesville, VA; and Richard J. Santen of the University of Virginia Health System in Charlottesville, VA.This CPG was co-sponsored by the Australasian Menopause Society, British Menopause Society, European Society of Endocrinology and the International Menopause Society.

The guideline was published online at http://press.endocrine.org/doi/10.1210/jc.2015-2236.

The Society established the CPG Program to provide endocrinologists and other clinicians with evidence-based recommendations in the diagnosis and treatment of endocrine-related conditions. Each CPG is created by a task force of topic-related experts in the field. Task forces rely on scientific reviews of the literature in the development of CPG recommendations as well as feedback from co-sponsoring societies, members of the Endocrine Society and expert reviewers. The Endocrine Society does not solicit or accept corporate support for its CPGs. All CPGs are supported entirely by Society funds. A list of CPGs can be found at http://www.endocrine.org/education-and-practice-management/clinical-practice-guidelines.

About Endocrine Society

Endocrinologists are at the core of solving the most pressing health problems of our time, from diabetes and obesity to infertility, bone health, and hormone-related cancers. The Endocrine Society is the world’s oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormone-related conditions.

The Society has more than 18,000 members, including scientists, physicians, educators, nurses, and students in 122 countries. To learn more about the Society and the field of endocrinology, visit our site at www.endocrine.org. Follow us on X (formerly Twitter) at @TheEndoSociety and @EndoMedia.