The Latest on Managing Menopausal Symptoms

JoAnn E. Manson, MD, DrPH


September 09, 2015

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Hello. This is Dr JoAnn Manson, professor of medicine at Harvard Medical School and Brigham and Women's Hospital. I'd like to bring to your attention a recent update on the management of menopausal symptoms, both the vasomotor symptoms and the genitourinary symptoms of menopause. Dr Andrew Kaunitz and I have a recent report on this subject in the journal Obstetrics and Gynecology. It's currently available online and will be in print in the October issue of the journal.[1]

What you'll find in this report is the latest information about hormonal and nonhormonal treatment options for the management of menopausal symptoms. We also provide an approach to clinical decision-making that's based on a personalized and individualized risk assessment in order to optimize the benefit-risk profile and the safety of treatment. Other information you'll find in this report is an overview of menopausal symptoms, the demographics, natural history, and risk factors for different symptoms. We provide information about the different hormone therapy options, oral versus transdermal, and different doses of hormone therapy. For the nonhormonal options: the benefits and risks of the NSSRIs, SNRIs, gabapentin, pregabalin, clonidine, and other options—pros and cons of each and the contraindications.

In addition to this information, we provide an approach to clinical decision-making and a clinical decision support tool that's based on an algorithm of the North American Menopause Society. This is also available in a free mobile app called MenoPro that facilitates shared decision-making between patient and clinician by having a dual mode—one for the woman and one for the clinician. This mobile app and the information in the report provide extensive information about the different treatment options, the pros and cons of each, and an approach to deciding among the options.

In addition, we address some special patient populations that may be particularly challenging. These include women with early menopause, women with a history of breast cancer or an increased risk for breast cancer, those with a history of venous thromboembolism or endometriosis, and women who have persistent menopausal symptoms that have very long duration, or women who may request extended duration of hormone therapy treatment. We hope that this information will be helpful to you in your clinical decision-making about the management of menopausal symptoms, and will help women to make the most informed choices possible about their treatment.

Thank you so much for your attention. This is JoAnn Manson.


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