The North American Menopause Society (NAMS) has issued guidelines for care of women at midlife, based on the textbook Menopause Practice: A Clinician’s Guide. Published in Menopause, the recommendations cover more than 50 topics, including vasomotor symptoms, osteoporosis, and vulvovaginal health.
Many of the statements in the new report are graded in one of three categories: Level I (good and consistent scientific evidence,) Level II (limited or inconsistent scientific evidence; and Level III (primarily consensus and expert opinion). Recommendations for which NAMS found Level I evidence include:
- Menstrual-cycle monitoring with paper or an electronic menstrual calendar to determine the onset and course of the menopause transition;
- Use of levels of antimÏllerian hormone, cycle day-3 follicle-stimulating hormone and estradiol, and ovarian antral follicle count in counseling related to fertility rather than as a means of predicting time to menopause;
- Evaluation of primary ovarian insufficiency in any woman younger than age 40 who misses at least 3 consecutive menstrual cycles;
- Consideration of use of low-dose oral contraceptives for treatment of heavy or irregular bleeding during menopause in healthy nonsmokers;
- Thorough evaluation of heavy or irregular bleeding at midlife and comprehensive evaluation of perimenopausal women with abnormal uterine bleeding and postmenopausal women with any bleeding;
- Bone mineral density testing for all women age 65 and older and consideration for treatment of osteoporosis or low bone mass in those with a 10-year probability of hip fracture of at least 3% or of a major osteoporosis-related fracture of at least 20%;
- Consideration of treatment for hot flashes that are bothersome, disrupt sleep, or adversely affect a woman’s quality of life;
- Treatment of persistent vulvovaginal symptoms with low-dose vaginal estrogen alone, use of ospemifene for moderate to severe dyspareunia due to vulvovaginal atrophy, and use of low-dose vaginal estrogen or prophylactic antibiotics in postmenopausal women with recurrent urinary tract infections;
- Use of testosterone therapy in carefully selected postmenopausal women with female sexual interest/arousal disorder;
- Visual evaluation of the postmenopausal vulva and vagina and biopsy of any white, pigmented, or thickened vulvar or vaginal lesions;
- Screening for obesity and use of interventions for it based on body mass index and comorbidities; and
- Counseling of women on the dangers of sun exposure and avoidance of midday sun and tanning salons and use of sunscreen and protective attire.
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The panel that prepared the report and the guidelines, NAMS said, comprised “experts in midlife women’s health from a wide range of specialties who devoted significant time and effort to ensuring the accuracy and relevance of each key point and clinical recommendation.” All of the panelists were asked to provide information on any financial conflicts of interest they or their spouses may have had in the past 12 months relevant to commercial interests related to the content of the guidelines.
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