• National consensus on the management of patients in menopause 
en To content

National consensus on the management of patients in menopause 

HEALTH OF WOMAN. 2016.4(110):17–27 
 

National consensus on the management of patients in menopause 
 

de Villiers Tobie, Tatarchuk T. F.

International society for menopause, national South African Foundation for osteoporosis

SI «Institute of Pediatrics, obstetrics and gynecology NAMS of Ukraine», Kyiv 
 

This document provides an overview of existing diagnosis and treatment methods of menopausal disorders in women, proposed algorithms for diagnosis and treatment of this disease to prevent heart diseases, osteoporosis and improve the quality of ukrainian women life.

The only pathogenetically effective method for the correction of menopausal disorders is menopausal hormone therapy. For this therapy are used natural estrogen (17в-estradiol, estradiol valerate, estriol) in combination with progestins (dydrogesterone) or androgens. It is possible parenteral (injections), transdermal, vaginal and oral hormone introduction.

To correct the climacteric syndrome, urogenital disorders are used short courses of menopausal hormone therapy (for 1–5 years). For the prevention and treatment of osteoporosis menopausal hormone therapy lasts over 3 years if necessary, in combination with a biphosphonate.


Key words: consensus, Association of Gynecologists-Endocrinologists of Ukraine, climacteric, menopause, perimenopause, postmenopausal period, menopausal hormone therapy.


REFERENCES

1. The North American Menopause Society position statement. «Management of osteoporosis in postmenopausal women: 2010 position statement of The North American Menopause Society». 2010. Menopause 17: 25–54.

2. de Villiers TJ, Pines A, Panay N et al. 2013. «Updated 2013 International Menopause Society recommendations on menopausal hormone therapy and preventive strategies for midlife health». Climacteric 16:316–37. http://dx.doi.org/10.3109/13697137.2013.795683; PMid:23672656

3. Santen RJ, Allred DC, Ardoin SP et al. 2010. «Postmenopausal hormone therapy: An Endocrine Society Scientific Statement». J Clin Endocrinol Metab 95.7.1:1–66. http://dx.doi.org/10.1210/jc.2009-2509; PMid:20566620

4. Wierman ME, Basson R, Davis SR et al. 2006. «Androgen therapy in women: an Endocrine Society clinical practice guideline». J Clin Endocrinol Metab 91:3697–710. http://dx.doi.org/10.1210/jc.2006-1121; PMid:17018650

5. National Institutes of Health. «National Institutes of Health State-of-the-Science Conference Statement: management of menopause-related symptoms». Ann Intern Med. 2005. 142:1003–13. http://dx.doi.org/10.7326/0003-4819-142-12_Part_1-200506210-00117; PMid:15968015

6. Bell RJ, Lijovic M, Fradkin P, Davis SR. 2008. «A pragmatic approach to the classification of menopausal status for community-based research». Menopause 15:978–83. http://dx.doi.org/10.1097/gme.0b013e318162c487; PMid:18779681

7. Gold EB, Crawford SL, Avis NE et al. 2013. «Factors related to age at natural menopause: longitudinal analyses from SWAN». Am J Epidemiol 178:70–83. http://dx.doi.org/10.1093/aje/kws421; PMid:23788671 PMCid:PMC3698989

8. Qiu C, Chen H, Wen J et al. 2013. «Associations between age at menarche and menopause with cardiovascular disease, diabetes, and osteoporosis in Chinese women». J Clin Endocrinol Metab 98:1612–21. http://dx.doi.org/10.1210/jc.2012-2919; PMid:23471979

9. Castelo-Branco C, Blumel JE, Chedraui P et al. 2006. «Age at menopause in Latin America». Menopause 13:706–12.

10. Harlow SD, Gass M, Hall JE et al. 2012. «Executive summary of the Stages of Reproductive Aging Workshop 10: addressing the unfinished agenda of staging reproductive aging». J Clin Endocrinol Metab 97:1159–68.

11. Zumoff В, Strain GW, Miller LK, Rosner W. 1995. «Twenty-four hour mean plasma testosterone concentration declines with age in normal premenopausal women». J Clin Endocrinol Metab 80.4:1429–30.

12. Davison SL, Bell R, Donath S et al. 2005. «Androgen levels in adult females: changes with age, menopause, and oophorectomy». J Clin Endocrinol Metab 90:3847–53.

13. Burger HG, Dudley EC, Cui J et al. 2000. «A prospective longitudinal study of serum testosterone, dehydroepiandrosterone sulfate, and sex hormone-binding globulin levels through the menopause transition». J Clin Endocrinol Metab 85:2832–8.

14. Judd HL, Lucas WE, Yen SS. 1974. «Effect of oophorectomy on circulating testosterone and androstenedione levels in patients with endometrial cancer». Am J Obstet Gynecol 118:793–8.

15. van der Stege JG, Groen H, van Zadelhoff SJ et al. 2008. «Decreased androgen concentrations and diminished general and sexual wellbeing in women with premature ovarian failure». Menopause 15:23–31.

16. Kalantaridou SN, Calis KA, Vanderhoof VH et al. 2006. «Testosterone deficiency in young women with 46, XX spontaneous premature ovarian failure». Fertil Steril 86:1475–82.

17. Van Look PF, Lothian H, Hunter WM et al. 1977. «Hypothalamic-pituitary-ovarian function in perimenopausal women». Clin Endocrinol 7:13–31.

18. Gold ЕВ, Colvin A, Avis N et al. 2006. «Longitudinal analysis of the association between vasomotor symptoms and race/ethnicity across the menopausal transition: Study of Women’s Health Across the Nation». Am J Public Health 96:1226–35.

19. Mishra GD, Kuh D. 2012. «Health symptoms during midlife in relation to menopausal transition: British prospective cohort study». BMJ 344:e402.

20. Avis NE, Brockwell S, Randolph JF Jr et al. 2009. «Longitudinal changes in sexual functioning as women transition through menopause: results from the Study of Women’s Health Across the Nation». Menopause 16:442–52.

21. Chuni N, Sreeramareddy CT. 2011. «Frequency of symptoms, determinants of severe symptoms, validity of and cut-off score for Menopause Rating Scale (MRS) as a screening tool: a cross-sectional survey among midlife Nepalese women». BMC Women’s Health 11:30.

22. Olaolorun FM, Lawoyin ТО. 2009. «Experience of menopausal symptoms by women in an urban community in Ibadan, Nigeria». Menopause 16:822–30.

23. Waidyasekera H, Wijewardena K, Lindmark G, Naessen Т. 2009. «Menopausal symptoms and quality of life during the menopausal transition in Sri Lankan women». Menopause 16:164–70.

24. Blumel JE, Chedraui P, Baron G et al. 2011. «A large multinational study of vasomotor symptom prevalence, duration, and impact on quality of life in middle-aged women». Menopause 18:778–85.

25. Vikstrom J, Spetz Holm AC, Sydsjo G et al. 2013. «Hot flushes still occur in a population of 85-year-old Swedish women». Climacteric 16:453–9.

26. Kroenke CH, Caan BJ, Stefanick ML et al. 2012. «Effects of a dietary intervention and weight change on vasomotor symptoms in the Women’s Health Initiative». Menopause 19:980–8.

27. Elavsky S, Gonzales JU, Proctor DN et al. 2012. «Effects of physical activity on vasomotor symptoms: examination using objective and subjective measures». Menopause 19:1095–103.

28. de Villiers TJ, Gass ML, Haines CJ et al. 2013. «Global Consensus Statement on menopausal hormone therapy». Climacteric 16:203–4.

29. The North American Menopause Society. «Estrogen and progestogen use in peri- and postmenopausal women: March 2007 position statement of The North American Menopause Society». Menopause. 2007. 14:168–82.

30. Chrisman C, Ribeiro P, Dalton VK. 2007. «The levonorgestrel-releasing intrauterine system: an updated review of the contraceptive and noncontraceptive uses». Clin Obstet Gynecol 50:886–97.

31. Simon JA. 2014. «What if the Women’s Health Initiative had used transdermal estradiol and oral progesterone instead?» Menopause 21:769–83.

32. Fournier A, Fabre A, Mesrine S et al. 2008. «Use of different postmenopausal hormone therapies and risk of histology- and hormone receptor-defined invasive breast cancer». J Clin Oncol 26:1260–8.

33. Leonetti H, Longo S, Anasti J. 1999. «Transdermal progesterone cream for vasomotor symptoms and postmenopausal bone loss». Obstet Gynecol 94:225–8.

34. Leonetti HB, Wilson KJ, Anasti JN. 2003. «Topical progesterone cream has an antiproliferative effect on estrogen stimulated endometrium». Fertil Steril 79:221–2.

35. Cooper A, Spencer MI, Whitehead M et al. 1998. «Systemic absorption of progesterone from Progest cream in postmenopausal women». Lancet 351:1255.

36. Birkhauser MH, Panay N, Archer DF et al. 2008. «Updated practical recommendations for hormone replacement therapy in the peri- and postmenopause». Climacteric 11:108–23.

37. Nijland EA, Weijmar Schultz WC, Nathorst-Boos J et al. 2008. «Tibolone and transdermal E2/NETa for the treatment of female sexual dysfunction in naturally menopausal women: results of a randomized active-controlled trial». J Sex Med 5:646–56.

38. Cummings SR, Ettinger В, Delmas PD et al. 2008. «The effects of tibolone in older postmenopausal women». N Engl J Med 359:697–708.

39. Pinkerton JV, Abraham L, Bushmakin AG et al. 2014. «Evaluation of the efficacy and safety of bazedoxifene/ conjugated estrogens for secondary outcomes including vasomotor symptoms in postmenopausal women by years since menopause in the Selective Estrogens, Menopause and Response to Therapy (SMART) Trials». J Womens Health (Larchmt) 23:18–28.

40. Mirkin S, Komm BS, Pan K, Chines AA. 2013. «Effects of bazedoxifene/conjugated estrogens on endometrial safety and bone in postmenopausal women». Climacteric 16:338–46.

41. de Villiers TJ, Chines AA, Palacios S et al. 2011. «Safety and tolerability of bazedoxifene in postmenopausal women with osteoporosis: results of a 5-year, randomized, placebo-controlled phase 3 trial». Osteoporos Int 22:567–76.

42. Pinkerton JV, Komm BS, Mirkin S. 2013. «Tissue selective estrogen complex combinations with bazedoxifene/conjugated estrogens as a model». Climacteric 16:618–28.

43. Portman DJ, Bachmann GA, Simon JA. 2013. «Ospemifene, a novel selective estrogen receptor modulator for treating dyspareunia associated with postmenopausal vulvar and vaginal atrophy». Menopause 20:623–30.

44. Simon J, Portman D, Mabey RG Jr. 2014. «Long-term safety of ospemifene (52-week extension) in the treatment of vulvar and vaginal atrophy in hysterectomized postmenopausal women». Maturitas 77:274–81.

45. Shams Т, Firwana В, Habib F et al. 2014. «SSRIs for hot flashes: a systematic review and meta-analysis of randomized trials». J Gen Intern Med 29:204–13.

46. Salmi Т, Punnonen R. 1979. «Clonidine in the treatment of menopausal symptoms». Int J Gynaecol Obstet 16:422–6.

47. Lindsay R, Hart DM. 1978. «Failure of response of menopausal vasomotor symptoms to clonidine». Maturitas 1:21–5.

48. Bolli P, Simpson FO. 1975. «Clonidine in menopausal flushing: a double-blind trial». N Z Med J 82:196–7.

49. Pandya KJ, Raubertas RF, Flynn PJ et al. 2000. «Oral clonidine in post- menopausal patients with breast cancer experiencing tamoxifen-induced hot flashes: a University of Rochester Cancer Center Community Clinical Oncology Program study». Ann Intern Med 132:788–93.

50. Lavigne JE, Heckler C, Mathews JL et al. 2012. «A randomized, controlled, double-blinded clinical trial of gabapentin 300 versus 900 mg versus placebo for anxiety symptoms in breast cancer survivors». Breast Cancer Res Treat 136:479–86.

51. Pandya KJ, Morrow GR, Roscoe JA et al. 2005. «Gabapentin for hot flashes in 420 women with breast cancer: a randomised double-blind placebo-controlled trial». Lancet 366:818–24.

52. Nguyen ML. 2013. «The use of pregabalin in the treatment of hot flashes». Can Pharm J 146:193–6.

53. Elkins GR, Fisher WI, Johnson AK et al. 2013. «Clinical hypnosis in the treatment of postmenopausal hot flashes: a randomized controlled trial». Menopause 20:291–8.

54. Mann Е, Smith MJ, Hellier J et al. 2012. «Cognitive behavioural treatment for women who have menopausal symptoms after breast cancer treatment (MENOS 1): a randomised controlled trial». Lancet Oncol 13:309–18.

55. Ayers В, Hunter MS. 2013. «Health-related quality of life of women with menopausal hot flushes and night sweats». Climacteric 16:235–9.

56. Lipov EG, Joshi JR, Sanders S et al. 2008. «Effects of stellate-ganglion block on hot flushes and night awakenings in survivors of breast cancer: a pilot study». Lancet Oncol 9:523–32.

57. Davis SR, Davison SL, Donath S, Bell R. 2005. «Relationships between circulating androgen levels and self-reported sexual function in women». JAMA 294:91–6.

58. Simon J, Braunstein G, Nachtigall L et al. 2005. «Testosterone patch increases sexual activity and desire in surgically menopausal women with hypoactive sexual desire disorder». J Clin Endocrinol Metab 90:5226–33.

59. Davis SR, Moreau M, Kroll R et al. 2008. «Testosterone for low libido in menopausal women not taking estrogen therapy». N Engl J Med 359:2005–17.

60. Panay N, Al-Azzawi F, Bouchard C et al. 2010. «Testosterone treatment of HSDD in naturally menopausal women: the ADORE study». Climacteric 13:121–31.

61. Davis SR, Panjari M, Stanczyk FZ. 2011. «DHEA replacement for postmenopausal women». J Clin Endocrinol Metab 96:1642–53.

62. Alkatib AA, Cosma M, Elamin MB et al. 2009. «A systematic review and meta-analysis of randomized placebo-controlled trials of DHEA treatment effects on quality of life in women with adrenalin sufficiency». J Clin Endocrinol Metab 94:3676–81.

63. Tatarchuk TF, Yefymenko OA, Islamova HO. 2013. «Menopause: a new look at an old problem». Reproductive Endocrinology 1.9.

64. Lokshin VN, Petrenko AA, Arefyeva NE. 2005. «Influence of the reproductive system diseases on the quality of women life». Russian Messenger for Obstetrician-Gynecologist 5.1:52–5.

65. Tatarchuk TF, Yefymenko OA. 2009. «Principles of diagnostics, prevention and treatment of menopausal disorders». Journal of Ukrainian Medical Elite 4.10:24–9.

66. Mazur IP, Povoroznyuk VV. 2002. «Skeletal system and periodontal disease». Modern Stomatology 3:32–40.

67. «Consensus Development Conference Diagnosis, prophylaxis, and treatment of osteoporosis». Am J Med. 1993. 94:646–50. DOI: 10.1016/0002-9343(93)90218-E

68. Kanis JA, McCloskey Е, Johansson H et al. 2012. «FRAX® with and without bone mineral density». Calcif Tissue Int 90:1–13. DOI: 10.1007/s00223-011-9544-7

69. Kanis JA, McCloskey EV, Johansson H, Cooper C et al. 2013. Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and the Committee of Scientific Advisors of the International Osteoporosis Foundation (IOF). «European guidance for the diagnosis and management of osteoporosis in postmenopausal women». Osteoporos Int 24.1:23–57. DOI: 10.1007/s00198-012-2074-y

70. WHO Study Group. «World Health Organisation Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group». World Health Organ Tech Rep Ser 1994. 843:1–129.

71. Okechukwu Ibeanu, Susan Modesitt C, Jennifer Ducie. 2011. «Hormone replacement therapy in gynecologic cancer survivors: Why not?» Gynecologic Oncology 122.2:447–54.

72. Geza Acs, Michael Wagoner J. 2010. «Postmenopausal hormone therapy and breast cancer-clinicopathological associations and molecular mechanisms». Cancer Growth and Progression 12:187–202.

73. Michaelson-Cohen R, Beller U. 2009. «Managing menopausal symptoms after gynecological cancer». Current Opinion in Oncology 21.5:407–11.

74. Mueck AO, Seeger H. 2004. «Hormone therapy after endometrial cancer». Endocrine-Related Cancer 11:305–14.

75. Piksi Singh, Martin Oehler K. 2010. «Hormone replacement after gynaecological cancer». Maturitas 65.3:190–7.

76. Michaelson-Cohen R, Beller U. 2009. «Managing menopausal symptoms after gynecological cancer». Current Opinion in Oncology 21.5:407–11.

77. Biglia N, Gadducci A, Ponzone R et al. 2004. «Hormone replacement therapy in cancer survivors». Maturitas 48:333–46.

78. Neal Freedman D, Wong-Ho Chow, Yu-Tang Gao et al. 2007. «Menstrual and reproductive factors and gastric cancer risk in a large prospective study of women». Gut 56:1671–1677.

79. Lindblad P, Mellemgaard A, Schlehofer B et al. 1995. «International renal-cell cancer study. Reproductive factors, gynecologic operations and exogenous hormones». International Journal of Cancer 61.2:192–8.

80. Cantwell MM, Lacey JV Jr, Schairer C et al. 2006. «Reproductive factors, exogenous hormone use and bladder cancer risk in a prospective study». International Journal of Cancer 119.10:2398–2401.

81. Razavi P, Pike MC, Horn-Ross PL et al. 2010. «Long-term Postmenopausal Hormone Therapy and Endometrial Cancer». Cancer Epidemiol Biomarkers 19:475–83.

82. Harlow SD, Gass M, Hall JE, Lobo R et al. 2012. «Executive Summary of the Stages of Reproductive Aging Workshop + 10». Menopause 19.4:387–39.