SOGC CLINICAL PRACTICE GUIDELINE
Managing Menopause

https://doi.org/10.1016/S1701-2163(15)30487-4Get rights and content

Abstract

Objective

To provide updated guidelines for health care providers on the management of menopause in asymptomatic healthy women as well as in women presenting with vasomotor or urogenital symptoms and on considerations related to cardiovascular disease, breast cancer, urogynaecology, and sexuality.

Outcomes

Lifestyle interventions, prescription medications, and complementary and alternative therapies are presented according to their efficacy in the treatment of menopausal symptoms. Counselling and therapeutic strategies for sexuality concerns in the peri- and postmenopausal years are reviewed. Approaches to the identification and evaluation of women at high risk of osteoporosis, along with options for prevention and treatment, are presented in the companion osteoporosis guideline.

Evidence

Published literature was retrieved through searches of PubMed and The Cochrane Library in August and September 2012 with the use of appropriate controlled vocabulary (e.g., hormone therapy, menopause, cardiovascular diseases, and sexual function) and key words (e.g., hormone therapy, perimenopause, heart disease, and sexuality). Results were restricted to clinical practice guidelines, systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Results were limited to publication dates of 2009 onwards and to material in English or French. Searches were updated on a regular basis and incorporated in the guideline until January 5, 2013. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, national and international medical specialty societies, and clinical practice guideline collections.

Values

The quality of the evidence in this document was rated using the criteria described by the Report of the Canadian Task Force on Preventive Health Care (Table).

Section snippets

Recommendations for Patients

  • 1.

    Women aged 51 to 70 should consume 7 servings of vegetables and fruits, 6 of grain products, 3 of milk and alternatives, and 2 of meat and alternatives daily. (III-A)

  • 2.

    A diet low in sodium and simple sugars, with substitution of unsaturated fats for saturated and trans fats, as well as increased consumption of fruits, vegetables, and fibre, is recommended. (I-A)

  • 3.

    Routine vitamin D supplementation and calcium intake for all Canadian adults year round is recommended. (I-A)

  • 4.

    Achieving and maintaining a

Summary Statements

  • 1.

    Determinants of sexual function involve central and peripheral mechanisms. (II-2)

  • 2.

    Both testosterone and estrogen have effects on sexual function. (I)

  • 3.

    The serum testosterone level is not a useful marker for the diagnosis of sexual dysfunction. (II-1)

  • 4.

    Estrogen’s primary action is on maintenance of vaginal and vulvar health. (II-2)

Recommendations

  • 1.

    Vulvovaginal atrophy should be addressed in all middle-aged women who complain of sexual dysfunction. (I-A)

  • 2.

    Serum androgen measurements should not be used in the assessment

Summary Statements

  • 1.

    Taking a brief sexual history is part of the evaluation of the menopausal woman. (III)

  • 2.

    Female dysfunction can be categorized into desire, arousal, pain, and orgasm problems. These categories often overlap. (II-2)

  • 3.

    Low desire with distress is most common in mid-life women. (II-2)

  • 4.

    Vaginal atrophy occurs in 50% of women within 3 years of menopause and is a common cause of sexual pain in menopausal women. (II-1)

  • 5.

    Sexual pain results in a cascade of detrimental sexual symptoms. (II-1)

  • 6.

    The treatment of

Summary Statements

  • 1.

    Sexual dysfunction is common in depressed patients and those taking selective serotonin reuptake inhibitors. (I)

  • 2.

    Premature loss of ovarian function may be attended by sexual dysfunction related to loss of both ovarian estrogen and androgen production at a time of life when sexual activity is normally heightened. (II-1)

  • 3.

    Survivors of breast cancer using aromatase inhibitors have more sexual dysfunction due to vulvovaginal atrophy than do women using tamoxifen or control subjects. (II-1)

Recommendations

  • 1.

    Patients

References (0)

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This clinical practice guideline has been prepared by the Menopause and Osteoporosis Working Group, reviewed by the Clinical Practice Gynaecology and Family Physician Advisory Committees, and approved by the Executive and Council of the Society of Obstetricians and Gynaecologists of Canada.

The literature searches and bibliographic support for this guideline were undertaken by Becky Skidmore, Medical Research Analyst, Society of Obstetricians and Gynaecologists of Canada.

Acknowledgement: Claudio N. Soares, MD, PhD, Toronto ON

Disclosure statements have been received from all contributors.

This document reflects emerging clinical and scientific advances on the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions. They should be well documented if modified at the local level. None of these contents may be reproduced in any form without prior written permission of the SOGC

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