ACOG Revises Guidelines on Treating Menopause Symptoms

The recommendations are listed in 3 tiers:
  • Level A ("good or consistent scientific evidence"):
    • Systemic HT, with just estrogen or estrogen plus progestin, is the most effective approach for treating vasomotor symptoms.
    • Low-dose and ultra-low systemic doses of estrogen have a more favorable adverse effect profile than standard doses.
    • Healthcare providers should individualize care and use the lowest effective dose for the shortest duration.
    • Thromboembolic disease and breast cancer are risks for combined systemic HT.
    • Selective serotonin reuptake inhibitors, selective serotonin and norepinephrine reuptake inhibitors, clonidine, and gabapentin relieve vasomotor symptoms and are alternatives to HT.
    • Local estrogen therapy is advised for isolated atrophic vaginal symptoms.
    • The only nonhormonal therapy approved to treat vasomotor symptoms is paroxetine, and to treat dyspareunia is ospemifene.
  • Level B conclusions ("limited or inconsistent scientific evidence"):
    • Data do not support use of progestin alone, testosterone, compounded bioidentical hormones, phytoestrogens, herbal supplements, and lifestyle modifications.
    • "Common sense lifestyle solutions" are layering clothing, lowering room temperature, and consuming cool drinks.
    • Nonestrogen water-based or silicone-based lubricants and moisturizers may alleviate pain.
  • Level C recommendation ("based primarily on consensus and expert opinion"):
    • Individualize the decision to continue HT.
Obstet Gynecol. 2014;123:202-216. Abstract


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