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

Objective: The objective of this document is to generate a practice guideline for the management
and treatment of symptoms of the menopause.

Participants: The Treatment of Symptoms of the Menopause Task Force included six experts, a
methodologist, and a medical writer, all appointed by The Endocrine Society.

Evidence: The Task Force developed this evidenced-based guideline using the Grading of Recommendations,
Assessment, Development, and Evaluation (GRADE) system to describe the strength
of recommendations and the quality of evidence. The Task Force commissioned three systematic
reviews of published data and considered several other existing meta-analyses and trials.

Consensus Process: Multiple e-mail communications, conference calls, and one face-to-face meeting
determined consensus. Committees of The Endocrine Society, representatives from endorsing
societies, and members of The Endocrine Society reviewed and commented on the drafts of the
guidelines. The Australasian Menopause Society, the British Menopause Society, European Menopause
and Andropause Society, the European Society of Endocrinology, and the International
Menopause Society (co-sponsors of the guideline) reviewed and commented on the draft.

Conclusions: Menopausal hormone therapy (MHT) is the most effective treatment for vasomotor
symptoms and other symptoms of the climacteric. Benefits may exceed risks for the majority of symptomatic
postmenopausal women who are under age 60 or under 10 years since the onset of menopause.
Health care professionals should individualize therapy based on clinical factors and patient
preference. They should screenwomenbefore initiatingMHTfor cardiovascular and breast cancer risk
and recommend the most appropriate therapy depending on risk/benefit considerations. Current
evidence does not justify the use ofMHTto prevent coronary heart disease, breast cancer, or dementia.
Other options are available for those with vasomotor symptoms who prefer not to use MHT or who have
contraindications because these patients should not useMHT.Low-dose vaginal estrogen and ospemifene
provide effective therapy for the genitourinary syndrome of menopause, and vaginal moisturizers and
lubricants are available for those not choosing hormonal therapy. All postmenopausal women should
embrace appropriate lifestyle measures. (J Clin Endocrinol Metab 100: 3975–4011, 2015)