Guidelines for Management of Menopausal Symptoms Issued
Care should be personalized; lowest effective dose recommended for shortest time to relieve symptoms
MONDAY, Jan. 6, 2014 (HealthDay News) -- Evidence-based treatment guidelines for menopause management include personalizing treatment for optimal symptom relief, according to a Practice Bulletin published in the January issue of Obstetrics & Gynecology.
Researchers from the American College of Obstetricians and Gynecologists have produced evidence-based guidelines for the management of menopausal symptoms. These symptoms include vasomotor (hot flushes) and vaginal symptoms (symptoms of vaginal atrophy), but the most commonly reported symptoms are vasomotor, with prevalence of 50 to 82 percent.
Based on good or consistent scientific evidence, the researchers recommend systemic hormone therapy, with the most effective therapy for vasomotor symptoms estrogen alone or in combination with progestin. A better adverse effect profile is seen with low-dose and ultra-low systemic doses of estrogen compared with standard doses. Health care providers should personalize care and treat women with the lowest effective dose of hormone therapy for the shortest duration needed to relieve symptoms, given the associated risks, which include thromboembolic disease and breast cancer for combined systemic hormone therapy. Alternatives to hormone therapy include selective serotonin reuptake inhibitors, gabapentin, and paroxetine for vasomotor symptoms. Estrogen therapy effectively relieves menopause-related atrophic vaginal symptoms. Scientific evidence is too limited or inconsistent to support use of progestin-only medication, testosterone, compounded bioidentical hormones, phytoestrogens, herbal supplements, or lifestyle modifications for the treatment of vasomotor symptoms. Common sense lifestyle solutions are reasonable for managing vasomotor symptoms.
"The purpose of this document is to provide evidence-based guidelines for the treatment of vasomotor and vaginal symptoms related to natural and surgical menopause," the authors write.