Summary of Canadian Menopause Society Guidelines for HCPs

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Menopause is a natural and unavoidable stage in a woman's life. However, the symptoms that come with it can have a major impact on a woman's quality of life. These symptoms include hot flashes, night sweats, sleep disturbances, vaginal dryness, and mood changes, among others.

Providing safe and effective management of these symptoms is crucial for maintaining a woman's health and well-being. In addition, it's important to mitigate potential health risks that may arise in postmenopausal years, such as osteoporosis, cardiovascular disease, and cognitive decline.

To guide healthcare providers in the management of menopause symptoms and related health risks, four professional associations have published guidelines. These include the Society of Obstetricians and Gynaecologists of Canada (SOGC 2014), the International Menopause Society (IMS 2016), the North American Menopause Society (NAMS 2017), and the Endocrine Society (ES 2015). These guidelines are based on extensive research and provide evidence-based recommendations for the management of menopause symptoms.

One study that caused controversy was the Women's Health Initiative (WHI) hormone therapy studies. The report concluded that the use of conjugated estrogens and medroxyprogesterone acetate in postmenopausal women was associated with increased risks of breast cancer, coronary heart disease, and stroke. As a result, the use of hormone therapy in postmenopausal women was largely abandoned in the years that followed.

However, it's important to note that the WHI hormone therapy studies were not designed to assess the risks of hormone therapy in symptomatic women. Rather, they were designed to determine whether the benefits of hormone therapy seen in observational studies of younger menopausal women applied to older women as well. As a result, in general, hormone therapy in postmenopausal women should only be initiated in women who are under 60 years of age or who are less than 10 years past menopause.

When it comes to managing menopause symptoms, hormone therapy is the most effective treatment for bothersome vasomotor symptoms (VMS) with or without additional climacteric symptoms. The choice of hormone therapy must be individualized and tailored to each woman's symptoms, her need for disease prevention, her personal and family history, the results of relevant investigations, and her own preferences and expectations.

In choosing a dose for hormone therapy, the appropriate dose is one that minimizes risk while still providing benefit. For older women, lower doses may reduce cardiovascular risk. However, individualization should take into account the level of symptom control and effect on quality of life, as well as a woman's individual risk of cancer, coronary heart disease, and venous thromboembolism.

It's important to note that there appear to be no reasons to place mandatory limitations on the duration of hormone therapy. This is because hormone therapy has been shown to have proven health benefits for menopause symptoms, prevention of bone loss, cognition and mood issues, and (in observational studies) heart disease.

Apart from hormone therapy, other options for managing VMS include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), gabapentinoids, or clonidine. For women who have contraindications to hormone therapy or who wish to avoid it, these alternatives may be effective.

Finally, it's important to consider the impact of menopause on bone health. Postmenopausal osteoporosis results from a failure to attain peak bone density, accelerated bone loss after menopause, age-related bone loss, or a combination of factors. The 10-year probability of a fracture in an individual can be estimated using a model