International Menopause Society Research Articles

Unified clinical protocol of primary, secondary (specialized), tertiary (highly specialized) medical care “Menopausal disorders and other disorders in the perimenopausal period”

This protocol was developed on the basis of the clinical guideline “Menopausal disorders and other disorders in the perimenopausal period”, which is based on the principles of evidence-based medicine and takes into account the clinical guideline Recommendations on Women’s Midlife Health and Menopause Hormone Therapy, developed in 2016 by specialists of the International Menopause Society (IMS), and corresponds to the specifics of providing medical care in our country.Also, other international guidelines on menopause issues were used in the development of this protocol, such as: “Menopause: diagnosis and management” National Institute for Health and Care Excellence (NICE) guideline, 2019; сlinical guidance “Managing menopausal symptoms” Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), 2020; “The genitourinary syndrome of menopause” North American Menopause Society, (NAMS), 2020; British Menopause Society (BMS) & Women’s Health Concern (WHC) recommendations on hormone replacement therapy in menopausal women, 2020.The goal of the protocol: to ensure the organization of medical care, to establish uniform requirements for the diagnosis and treatment of patients with menopausal symptoms, to recommend the use of STRAW+10 (2011) criteria for menopause to all health care professionals.The protocol describes the organization of medical care for patients with menopausal disorders at all levels – from primary to tertiary care. Detailed information on diagnosis and treatment of this category of patients is presented. Special attention is paid to menopausal hormone therapy, taking into account its possible risks.The protocol is intended for general practitioners – family doctors, obstetrician-gynecologists, gynecological oncologists, oncologists, oncological surgeons, cardiologists, endocrinologists, orthopedic traumatologists and other medical professionals who provide medical assistance to women with menopausal disorders.

#Menopause: The Menopause Ontology Project

ABSTRACT Introduction Medical professionals and patients increasingly utilize social media to connect and share healthcare information. Twitter is a popular social media platform with 186 million users in 2020 alone. Twitter users employ hashtags-terms or phrases proceeded by the “#” symbol-to aggregate data about related subjects. Hashtag ontologies are groups of hashtags used to standardize terminology and facilitate easier communication. Objective To create a hashtag ontology specific to menopause. Methods This study analyzed tweets including the hashtag #menopause between November 2019 and November 2021 to identify co-occurring hashtags related to menopause. Tweets performed by the International Society for the Study of Women's Sexual Health, North American Menopause Society, International Menopause Society, and International Society of Sexual Medicine amongst others were included in analysis. To analyze hashtag utilization amongst all Twitter users, hashtags from the “Top” tweets Twitter search function from October 2021 were also analyzed. Co-occurring hashtags were recorded as well as the type of user who performed the tweet during the “Top” tweets analysis. The Society of Gynecologic Surgeons hashtag ontology was also reviewed as a cross reference and for completeness. Social media influencers and experts reviewed and edited the hashtag list. The hashtags were then grouped by subject and the ontology was finalized. Results We analyzed three-hundred eighty-two tweets with #menopause. Major societies produced 231 tweets and expert influencers produced 53 tweets. Using the “Top” tweets search function from October 2021, we identified 98 additional tweets. Of the users included in the “Top” tweets, 40% were patient advocates or advocacy groups; 38% were medical professionals, academics, societies, or journals; and 22% were general users. In total, 123 unique hashtags were identified. After social media influencer and expert review, 32 hashtags were included in the final ontology. The ontology was then grouped into the following categories based on subject matter: general, premature menopause, hormones, sexual function, and genital disorders. The finalized ontology appears in Table 1. Conclusions Social media is an important tool for medical professionals and patients. Our study is the first to develop a hashtag ontology specific to menopause. Adoption of a hashtag ontology with standardized terminology by medical professionals may facilitate easier communication with peers and patients. Disclosure No

Response to changes in menopausal symptoms after use of testosterone: a retrospective analysis

Background: Androgen therapy in the form of testosterone has been used for many years for the management of low sexual desire in women and this often becomes a problem for women during the menopause transition. Testosterone is currently recommended by the International Menopause Society, the British Menopause Society and the National Institute for Health and Care Excellence (NICE) for the treatment of diminished sexual desire that causes the affected woman to experience significant distress.

New trends in current menopausal hormone therapy

The article presents the results of recent studies on the effectiveness, safety and duration of menopausal hormone therapy (MHT). The main cardio-metabolic risk factors for cardiovascular diseases are formed in women precisely during the transition to menopause and are clearly associated with the appearance of vegetative menopausal symptoms and the development of endothelial dysfunction, which is a predictor of future serious health problems, especially cardiovascular diseases. The results of a number of epidemiological studies have shown that in women with severe climacteric manifestations, especially with hot flashes, the overall risk of developing cardiovascular diseases is increased. The need for early initiation of MHT is an indisputable truth and is not disputed by anyone, but the formed tendency to discontinue treatment in 56 years raises many questions among patients and their doctors. However, recent guidelines from the International Menopause Society state that there is no reason to arbitrarily limit the duration of MHT. This paper presents current evidence on the indications and benefits of low and ultra-low doses of MHT. In view of the high efficacy and safety of low doses of MHT, they seem to be the most acceptable starting doses of oral MHT for most women. In addition, women with early menopause should also receive higher doses of estrogens, as they are more physiological for them. The choice in favor of starting MHT in a postmenopausal woman with a low or ultra-low dose in each case should be selected individually.

Specifics of prescribing menopausal hormonal therapy in patients with the anamnestic endometriosis

Administration of menopausal hormone therapy (MHT) in patients with genital endometriosis (GE) is a controversial issue requiring a patient-personalized approach. Current principles for MHT selection and prescription in patients with anamnestic endometriosis are presented, which are based on the guidelines of the International Menopause Society (IMS), The European Menopause and Andropause Society, local and foreign publications retrieved from electronic data bases PubMed, Cyberleninka. The data of our study on observing 724 patients with GE treated with diverse MHT types were presented and analyzed (428 women in perimenopausal period, 296 in postmenopausal period). Patients with endometriosis in perimenopausal and postmenopausal periods showed more prominent manifestations of climacteric and post-ovariectomy syndromes, as well as high risk of reduced bone mineral density (BMD) due to repeated surgery on the ovaries and preceding long-term “antiestrogen therapy”. Custom-compounded MHT based on components combinations, dosage and administration route provides a significantly improved quality of life for patients with endometriosis, prevents loss of BMD and reduces risk of cardiovascular diseases. Using low and ultra-low dose estrogen bioidentical to natural substances in this patient group minimizes a risk of disease recurrence.

Concept of complications of reproductive aging in women for anti-aging therapy. Literature review

Modern mankind, through the development of medicine and using its scientifically grounded innovations has learned to prolong human life. In Ukraine as in the whole world there is a tendency to increase in life expectancy. Since aging is a natural physiological process, a person from time immemorial has been preoccupied with the search for the so-called “Philosophy Stone” is a substance that prevents aging.This article analyzes data from scientific publications on modern aspects of the problems associated with aging of the female body. It has been proven that aging and anti-aging processes substantiate the individualization of modern approaches to the correction of pre- and perimenopause complications. The general strategy for maintaining of women’s health in peri- and postmenopause according to the International Menopause Society includes menopausal hormone therapy, taking into accounts the therapy goals and individual risk factors. Despite all the desire to give a modern definition of aging, it is currently not possible, therefore in this literature review an attempt is made to analyze the known strategies of premature aging to develop the potential for prolonging active life.In any case, the doctor needs to correlate the benefits and risks of menopausal hormone therapy, taking into account individual risk factors and select appropriate rehabilitation methods aimed at “improving the female face” of the classic image of old age. Since the role of estrogen deficiency in the formation of perimenopausal complications and especially premature aging, is not questioned, anti-aging strategies should be considered a pathogenetically justified method of treating vasomotor, psychosomatic symptoms and sleep disorders, as well as a method of preventing metabolic syndrome. It should be remembered that hormone therapy has a number of limitations and contraindications, which is an incentive for every doctor to contribute to prolongation of the active and healthy life of women 40+ and 50+ years old. Creation of a conceptual model for overcoming the complications of reproductive aging and especially cardiovascular events, osteoporosis, cerebrovascular pathology based on the identification of risk factors will allow to develop the protective anti-aging therapy not only to prolong a woman's life, but also to improve its quality

Menopause: focus on additional therapy opportunities. Literature review

About 10% of the world's populations are menopausal women. This period coincides with the most active social and professional activities of almost every woman. In addition to typical manifestations, this age stage is characterized by menopausal metabolic syndrome, which is caused by estrogen deficiency and is found in 35–49% of women in older age groups.Modern approaches to the treatment and prevention of menopausal disorders include following principles: lifestyle changes, menopausal hormone therapy (MHT), non-hormonal therapy (drugs with hormone-like effects, phytoestrogens, selective modulators of estrogen receptors, β-alanine, sedatives, tranquilizers, and antidepressants), non-drug correction methods.According to the International Menopause Society recommendations (2016), MHT is a gold standard for prevention and treatment of menopausal disorders. However, the choice of MHT as a therapeutic standard is not always unambiguous and acceptable, because hormone therapy is associated with a number of side effects. In addition, there are a number of absolute contraindications for MHT. Therefore, the task of a gynecologist is to choose personalized (individual) therapy for menopausal disorders for each patient. Factors that must be considered when choosing between MHT and non-hormonal drugs include: severity and duration of menopause syndrome, presence of absolute and relative contraindications for MHT, patient’s desire, tolerance of the chosen method.Phytoestrogens (selective modulators of plant-derived estrogen receptors, which are structurally similar to endogenous estrogens) are well-researched among the means of non-hormonal therapy of menopausal patients. Due to their weak estrogenic action, they reduce the severity of menopausal syndrome without affecting the proliferative processes in the endometrium. Phytoestrogens are used by gynecologists in many countries for mild climacteric complaints and/or if there are absolute contraindications for MHT. One of these drugs is Climona® that is contains biologically active components of plant origin (hop cones, cimicifuga root, dioscorea root, vitamin D, α-lipoic acid), which have been shown to be effective in decrease of menopause manifestations and reducing menopausal metabolic syndrome

Abstract P6-11-01: Adherence to guidelines for bone health in a predominantly Hispanic cohort of breast cancer patients receiving aromatase inhibitors

Abstract Introduction: Aromatase inhibitors (AI), by reducing estrogen levels, decrease the risk of recurrence of hormone receptor positive breast cancer but also lead to accelerated bone loss and increased fracture risk. This has led to guidelines for treating women on AIs with bone antiresorptive agents earlier in order to avoid fractures. The 2017 joint position statement from the International Osteoporosis Foundation, Cancer and Bone Society, European Calcified Tissue Society, International Expert Group for AI Bone Loss, European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Disease, International Menopause Society, and the International Society for Geriatric Oncology recommends treating patients on AI with either denosumab or bisphosphonates with BMD T-scores < -2.0, T-scores < -1.5 with one additional risk factor, or with ≥ 2 risk factors even without a BMD for the duration of AI therapy. The Garbar Breast Care Center at TTUHSC-El Paso serves a predominantly Hispanic patient population. As disparities in cancer care have been well documented amongst minorities, we sought to determine the adherence to the current guidelines for fracture prevention in this group. Methods: Post-menopausal women diagnosed with non-metastatic breast cancer and receiving adjuvant AIs who had a BMD done were included. Patients with pre-existing osteoporosis or already receiving antiresorptive therapy prior to cancer diagnosis were excluded. Electronic medical records of patients seen in clinic between 9/2015 and 3/2018 were reviewed to extract data regarding bone mineral density (T score, Z score), risk factors, and use of antiresorptive therapies. Study was approved by the institutional IRB. Results: A total of sixty patients were included. Median age was 65 years and 92% were Hispanic. Stage distribution was as follows: I, 40%, II, 43% and III, 17%. Thirty-eight (63%) met criteria to be treated with an antiresorptive agent. Thirty-two (53%) had T-scores < -2.0 and 6 (10%) had a T-score < -1.5 with at least 1 additional risk factor. Only 15 (39%) of the 38 patients who met guidelines for treatment were on antiresorptive therapy. Of the 15 patients who were on treatment, 10 had osteoporosis (T-score < -2.5), and 5 had osteopenia (T-score -2 to -2.5). Two additional patients were on antiresorptive therapy that did not meet the guidelines. Of the remaining 23 patients who met guidelines for treatment but were not treated, 6 had frank osteoporosis, 11 had a T-score between -2.0 and -2.5, and 6 had T-scores < -1.5 with at least one additional risk factor. Perceived barriers to appropriate institution of anti-resorptive therapy amongst oncologists were a) lack of timely dental evaluation and risk of osteonecrosis, b) cost of denosumab and zoledronic acid c) risk of myalgias and arthralgias with anti-resorptive agents potentially affecting compliance with AI therapy. Conclusion: In a predominantly Hispanic population, we found that only 39% of patients with indications for anti-resorptive therapy were on appropriate treatment. This has important implications for long term bone health amongst these cancer survivors. As adjuvant bisphosphonates have also been associated with a decrease in bone metastases and improvement of breast cancer specific survival, the low rate of adherence to guidelines can potentially contribute to inferior long-term survival. Timely access to dental services can potentially improve compliance rates. Citation Format: Tamis M. Bright, Meghan K. Mcalice, Abelardo Escriba-Omar, Sumit Gaur, Alexander V. Philipovskiy. Adherence to guidelines for bone health in a predominantly Hispanic cohort of breast cancer patients receiving aromatase inhibitors [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-11-01.

Menopause guideline appraisal and algorithm development for premature ovarian insufficiency

ObjectivesClinical practice guidelines (CPGs) are systematically developed statements that guide clinicians to provide appropriate healthcare. The aims of this study were: 1) to systematically evaluate the quality of menopause management CPGs; 2) to identify menopause topics included in the CPGs; 3) to summarize the recommendations regarding either early menopause (EM) or premature ovarian insufficiency (POI) provided by high-scoring CPGs; and 4) to develop EM/POI management algorithms. Study designA systematic search for CPGs published between 2012 and 2017 was conducted using Medline, Embase, All EBM, CPG databases and medical websites. Appraisal was conducted by 4 independent reviewers using the Appraisal of Guidelines for Research & Evaluation II instrument (AGREE II). Inter-rater reliability was calculated using the intraclass correlation coefficient. Recommendations regarding EM/POI were extracted from high-scoring CPGs and translated into a management algorithm, which was refined on the basis of feedback from expert clinicians. ResultsThe systematic search yielded 22 CPGs for review. Only 2 were assessed as high quality, with 10 average and 10 considered low quality. Scope and purpose (73% ± 15%) and clarity of presentation (78% ± 15%) achieved the highest mean scores, while applicability scored the lowest (23% ± 18%). Inter-rater agreement was 0.74 (good) to 0.91 (very good). The most comprehensive CPGs were those developed by the National Institute for Health and Care Excellence (NICE), the International Menopause Society (IMS) and the European Menopause and Andropause Society (EMAS). ConclusionsMost menopause CPGs are poor to average quality and there is variation between them in EM/POI management recommendations. EM/POI management algorithms were developed from high-scoring CPGs.

Treatment of postmenopausal vulvovaginal atrophy with estriol: a scientific update for 2014–2018

Due to the increase in life expectancy, today, most women live in a state of estrogen deficiency for more than a third of their life time. According to the recent document on the stages of aging of the female reproductive system (the STRAW+10 working group), there are three main stages that include the reproductive period, the menopausal transition, and postmenopause. One of the most common manifestations of postmenopause is vulvovaginal atrophy or genitourinary syndrome, which leads to a dramatic decrease in the woman’s quality of life. Up to 45 % of postmenopausal women suffer from this disorder, and 80 % of them experience a negative impact on their quality of life. The main symptoms of vulvovaginal atrophy are dryness, itching, burning, and dyspareunia. Caution must be exercised in relation to “silent” atrophy, which is not manifested by subjective complaints of vaginal mucosa atrophy, and can only be visualized by colposcopy. According to the recommendations of the International Menopause Society (IMS), updated in 2016, therapy should be started before the atrophic changes become irreversible; the treatment should continue for a long time to maintain the achieved therapeutic effect. If no symptoms other than vulvovaginal atrophy are noted, local estrogen therapy is indicated. Estriol has advantages over other medications due to its lower affinity for estrogen receptors. In earlier studies as well as those updated here (2014–2018), estriol applied topically as a vaginal cream or vaginal suppositories, has a selective effect on the urogenital tract and practically does not interfere with the proliferation of the uterine endometrium. The confirmed efficacy and safety of estriol allow for its permanent use, beginning with the starting dose and then switching to the maintenance one.

Global Consensus Position Statement on the use of Testosterone Therapy for Women

This Statement is being simultaneously published in the journals Climacteric, Maturitas, Journal of Sexual Medicine, and Journal of Clinical Endocrinology and Metabolism on behalf of the International Menopause Society, The European Menopause and Andropause Society, The International Society for Sexual Medicine, and The Endocrine Society, respectively. This Position Statement has been endorsed by the International Menopause Society, The Endocrine Society, The European Menopause and Andropause Society, The International Society for Sexual Medicine, The International Society for the Study of Women's Sexual Health, The North American Menopause Society, The Federacion Latinoamericana de Sociedades de Climaterio y Menopausia, The Royal College of Obstetricians and Gynaecologists, The International Society of Endocrinology, The Endocrine Society of Australia, and The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Does menopause hormone therapy reduce the risk of chronic diseases?

The hormonal deficit of post menopause is not only linked to the classic hot flashes, but also to a higher risk of chronic diseases. Menopausal hormone therapy (MHT) adequately treats climacteric symptoms and can prevent some chronic diseases such as osteoporosis. The Women's Health Initiative (WHI) study, which indicated risks of MHT in elderly postmenopausal women, caused a massive withdrawal of this therapy. But, in recent years the results of the WHI have been challenged by methodological problems and by several studies indicating that, if MHT is initiated early and the non-oral route is preferred, the risks could be minimized and it could improve not only the quality of life but also reduce the risk of chronic diseases. However, the US Preventive Services Task Force (USPSTF) recommends against the use of MHT for the prevention of chronic diseases, a position that has been challenged by publications of the North American Menopause Society and the International Menopause Society. This controversy persists so far. We report data that suggest a preventive role of MHT in perimenopausal women.

Menopausia y Terapia Hormonal de la Menopausia Las recomendaciones 2018 de la Unidad de Endocrinología Ginecológica de Clínica Alemana de Santiago -Sociedad Italiana de la Menopausia y la Sociedad Chilena de Endocrinología Ginecológica

ABSTRACT In the last decade, the risk benefits ratio of MHT has been evaluated mainly in terms of cardiovascular risk. Present Consensus Statement is largely inspired by the Global Consensus on Menopausal Hormone Therapy in 2013 and 2016 by leading global menopause societies (The American Society for Reproductive Medicine, The Asia Pacific Menopause Federation, The Endocrine Society, The European Menopause and Andropause Society, The International Menopause Society, The International Osteoporosis Foundation and The North American Menopause Society). The aim of these Recommendations is to provide a simple and updated reference on postmenopausal MHT. The term MHT typically includes estrogen replacement therapy (ERT) and estrogen-progestogen therapy (EPT). EPT can be sequential (Seq) when progestogen is added to ERT for 10-14 days a month, or continuous combined (CC) when progestogen is administered continuously every day along with a fixed amount of estrogen. MHT also includes Tibolone and the Tissue Selective Estrogen Complex (TSEC).

Manejo terapéutico de la sintomatología climatérica

La menopausia ha sido definida por la Sociedad Internacional de Menopausia como el cese permanente de la menstruación en la mujer, suceso determinado por la disminución de la producción hormonal. Trae consigo, por una parte, una sintomatología que interfiere en la calidad de vida de la mujer, la cual incluye síntomas vasomotores, psíquicos, atrofia urogenital; y, por otra, cambios metabólicos que implican aumento del riesgo de enfermedades crónicas como las enfermedades cardiovasculares y la osteoporosis. Con el progresivo aumento de la esperanza de vida, los grupos de mayor edad comienzan a ser parte importante de la población mundial. Por lo tanto, el manejo clínico de la posmenopausia pasa a ser un problema relevante de salud pública. Tiene como objetivo mejorar la calidad de vida y disminuir el riesgo de enfermedades crónicas. Para medir la existencia de síntomas y signos asociados a la menopausia se puede utilizar la Menopause Rating Scale (MRS), escala que permite evaluar la intensidad de la sintomatología. Se debe valorar además el riesgo cardiovascular y de osteoporosis. El tratamiento incluye mejorar los estilos de vida, el uso de terapia hormonal y de terapias para las comorbilidades. Estas orientaciones tienen como objetivo ser una ayuda para el médico al momento de evaluar a una mujer en este periodo de la vida. Se han basado principalmente en las ‘Orientaciones Técnicas para la atención integral de la mujer en edad de climaterio en el nivel primario de red de salud’ del Programa de Salud de la Mujer, Ministerio de Salud, Chile. Sin embargo, son solo orientaciones; cada decisión terapéutica debe ser siempre individualizada acorde a las características particulares de cada paciente.

Menopause and hormone replacement therapy: the 2017 Recommendations of the Italian Menopause Society.

Over the last decade, the risk benefits ratio of hormone replacement therapy (HRT) has been reevaluated mainly in tens of cardiovascular risk. Present Consensus Statement is largely inspired by the Global Consensus on Menopausal Hormone Therapy in 2013 and 2016 by leading global menopause societies (The American Society for Reproductive Medicine, The Asia Pacific Menopause Federation, The Endocrine Society, The European Menopause and Andropause Society, The International Menopause Society, The International Osteoporosis Foundation and The North American Menopause Society). The aim of these recommendations is to provide a simple and updated reference on postmenopausal HRT. The term HRT typically includes estrogen replacement therapy (ERT) and estrogen-progestogen therapy (EPT). EPT can be sequential, when progestogen is added to ERT for 10-14 days a month, or continuous combined when progestogen is administered continuously every day along with a fixed amount of estrogen, In the everyday language, HRT includes also tibolone and the tissue-selective estrogen complex.

Use of cardiovascular age for assessing risks and benefits of menopausal hormone therapy.

The Women's Health Initiative studies and others have suggested that menopausal hormone therapy may enhance the risk of new cardiovascular (CV) events in older women and diminish the development of coronary atherosclerosis in younger women. The underlying mechanisms to explain these findings are encapsulated in the term "Timing Hypothesis." Extensive pathophysiologic studies have provided mechanistic evidence for the dichotomous effects of estrogen on coronary artery vasculature. Early in the atherosclerotic disease process, estrogen exerts protective effects on the endothelium and retards plaque formation. Late in the process, estrogen causes plaque erosion or rupture with subsequent thrombosis and acute coronary events. Analysis of the Timing Hypothesis in women examined in the Women's Health Initiative primarily used chronologic age to assess divergent effects of estrogen. The complexity of the data underlying coronary pathophysiology has resulted in controversy whether MHT can be used in older women or those with prior CV disease. In a debate of this issue at a recent International Menopause Society meeting, the concept of using CV age rather than chronologic age was discussed as a practical method of resolving this issue and facilitating therapeutic decisions in older women. This "Personal Perspective" will review the concepts underlying CV age, describe how it is determined, provide support for its utility, and propose future studies using this parameter.

An International Menopause Society study of vasomotor symptoms in Bangkok and Chiang Mai, Thailand

Objectives: To examine relationships between location, demographics, lifestyle, beliefs, and experience of hot flushes and night sweats (HFNS) amongst women living in two cities in Thailand.Methods: Cross-sectional study of peri- and postmenopausal women, aged 45–55 years, from Bangkok and Chiang Mai. Participants completed questionnaires (demographics, health, HFNS (prevalence, frequency and problem-rating) and beliefs about menopause). A sub-sample of women from each location was interviewed.Results: A total of 632 women (320 Bangkok and 312 Chiang Mai) aged 50.88 (standard deviation 3.06) years, took part. The prevalence of HFNS was 65%, average HFNS frequency 8.7 (10.8) per week and problem rating 4.3/10. Women from Chiang Mai had significantly more problematic HFNS, but prevalence and frequency were similar in both sites. Poor general health predicted HFNS prevalence and frequency, while Chiang Mai location, HFNS frequency, age, diet and beliefs about menopause were associated with problematic HFNS. Location remained significant after controlling for education, occupation and age; location was partially explained by beliefs. Qualitative interview responses illustrated the differences in beliefs about menopause between locations.Conclusion: HFNS reports are prevalent with moderate frequency and problem-ratings in these urban centers in Thailand. The results will be included in the broader International Menopause Society study of Climate, Altitude and Temperature (IMS-CAT) of the impact of climate on HFNS.

Рекомендации международного общества по менопаузе в отношении здоровья женщин зрелого возраста и менопаузальной гормональной терапии, 2016

The International Menopause Society (IMS) has produced these new 2016 recommendations on women’s midlife health and menopause hormone therapy to help guide health-care professionals in optimizing their management of women in the menopause transition and beyond. The term menopause hormone therapy has been used to cover therapies including estrogens, progestogens and combined regimens. Menopausal hormone therapy today is the most effective treatment for vasomotor symptoms and urogenital atrophy.For the first time, the 2016 International Menopause Society recommendations now include grades of recommendations, levels of evidence and ‘good practice points’, in addition to section-specific references. Where possible, the recommendations are based on and linked to the evidence that supports them, unless good-quality evidence is absent. Particular attention has been paid to published evidence from 2013 onwards, the last time the International Menopause Society recommendations were updated. Databases have been extensively searched for relevant publications using key terms specific to each specialist area within menopause physiology and medicine. Information has also been drawn from international consensus statements published by bodies such as the International Menopause Society, the European Menopause and Andropause Society and the North American Menopause Society.The recommendations have been produced by experts derived mainly from the International Menopause Society, with the assistance of key collaborators where deemed advantageous. In preparing these international recommendations, experts have taken into account geographical variations in medical care, prevalence of diseases, and country-specific attitudes of the public, medical community and health authorities towards menopause management. The variation in availability and licensing of menopause hormone therapy and other products has also been considered.

Revised global consensus statement on menopausal hormone therapy

The following Consensus Statement is endorsed by The International Menopause Society, The North American Menopause Society, The Endocrine Society, The European Menopause and Andropause Society, The Asia Pacific Menopause Federation, The International Osteoporosis Foundation and The Federation of Latin American Menopause Societies.

Лечение симптомов менопаузы. Клиническое практическое руководство эндокринологического общества США, 2015

The objective of this document is to generate a practice guideline for the management and treatment of symptoms of the menopause. The Treatment of Symptoms of the Menopause Task Force included six experts, a methodologist, and a medical writer, all appointed by The Endocrine Society. 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. 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 screen women before initiating MHT for cardiovascular and breast cancer risk and recommend the most appropriate therapy depending on risk/benefit considerations. Current evidence does not justify the use of MHT to 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 use MHT. 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.