Special Report: Latest updates, tailoring VMS treatment, and shared decision-making

In the fifth episode of the Contemporary OB/GYN Special Report series, JoAnn V. Pinkerton, MD, and Jill Liss, MD, MSCP, FACOG, discussed current clinical guidelines for managing vasomotor symptoms (VMS) and emphasized the importance of individualized care through shared decision-making.

Pinkerton outlined key updates from major medical societies, noting a clear consensus across the North American Menopause Society, the American College of Obstetricians and Gynecologists, and the Endocrine Society. “Menopause hormone therapy is the most effective treatment for hot flushes and night sweats in healthy women close to menopause,” she said, defining that population as those under 60 or within 10 years of menopause onset.¹ She added that transdermal hormone therapy, particularly estrogen-only regimens, offers safety advantages over oral formulations, with additional benefits for bone density, sleep, and quality of life.²

Liss highlighted how these unified recommendations provide clinicians with a strong evidence-based framework while still allowing flexibility to tailor care. “Consensus among multiple organizations gives clinicians such a toolbox to help guide decision making,” she said. “The art is in individualization—considering age, time since menopause, personal risk factors, and patient preferences.”

Both experts emphasized the central role of shared decision-making in achieving treatment success. Liss noted that when patients understand risks, benefits, and choices, adherence and satisfaction improve. Pinkerton agreed, adding that clinicians should begin by exploring each patient’s health concerns, values, and fears. “It’s really important to start where the patient is,” she said. “We now have so many options for women at different doses and types of therapies, including nonhormonal approaches, that we can personalize care more than ever before.”

Our Experts:
JoAnn V. Pinkerton, MD, division director, Midlife Health Center, University of Virginia.

Jill Liss, MD, MSCP, FACOG, associate clinical professor of Obstetrics and Gynecology, University of Colorado School of Medicine.

Liss has no relevant disclosures to report. Relevant disclosures for Pinkerton include Bayer.

References:

1. Mayo Clinic. Hormone therapy: Is it right for you? Mayo Clinic. December 6, 2022. Accessed October 17, 2025. https://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-therapy/ART-20046372
2. Comparative Evidence Between Transdermal and Oral Menopausal Hormone Therapy. Nih.gov. April 2025. Accessed October 17, 2025. https://www.ncbi.nlm.nih.gov/books/NBK614933/