title: Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline.
abstract: OBJECTIVE
  The objective of this document is to generate a practice guideline for the management and treatment of symptoms of the menopause.
  
  
  METHODS
  The Treatment of Symptoms of the Menopause Task Force included six experts, a methodologist, and a medical writer, all appointed by The Endocrine Society.
  
  
  METHODS
  The Task Force developed this evidenced-based guideline using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe the strength of recommendations and the quality of evidence. The Task Force commissioned three systematic reviews of published data and considered several other existing meta-analyses and trials.
  
  
  METHODS
  Multiple e-mail communications, conference calls, and one face-to-face meeting determined consensus. Committees of The Endocrine Society, representatives from endorsing societies, and members of The Endocrine Society reviewed and commented on the drafts of the guidelines. The Australasian Menopause Society, the British Menopause Society, European Menopause and Andropause Society, the European Society of Endocrinology, and the International Menopause Society (co-sponsors of the guideline) reviewed and commented on the draft.
  
  
  CONCLUSIONS
  Menopausal hormone therapy (MHT) is the most effective treatment for vasomotor symptoms and other symptoms of the climacteric. Benefits may exceed risks for the majority of symptomatic postmenopausal women who are under age 60 or under 10 years since the onset of menopause. Health care professionals should individualize therapy based on clinical factors and patient preference. They should screen women before initiating MHT for cardiovascular and breast cancer risk and recommend the most appropriate therapy depending on risk/benefit considerations. Current evidence does not justify the use of MHT to prevent coronary heart disease, breast cancer, or dementia. Other options are available for those with vasomotor symptoms who prefer not to use MHT or who have contraindications because these patients should not use MHT. Low-dose vaginal estrogen and ospemifene provide effective therapy for the genitourinary syndrome of menopause, and vaginal moisturizers and lubricants are available for those not choosing hormonal therapy. All postmenopausal women should embrace appropriate lifestyle measures.
authors.affiliation: University of California, San Diego, Endocrine/Metabolism (C.A.S.), La Jolla, California 92093; Monash University, School of Public Health and Preventive Medicine (S.R.D.), Melbourne 03004, Australia; Université Paris Descartes, Hôpitaux Universitaires Port Royal-Cochin Unit de Gynécologie Endocrnienne (A.G.), Paris 75014, France; University of Glasgow School of Medicine (M.A.L.), Glasgow G31 2ER, Scotland; Mayo Clinic, Division of Preventive Medicine (M.H.M.), Rochester, Minnesota 55905; University of Virginia, Obstetrics and Gynecology (J.V.P.), Charlottesville, Virginia 22908; and University of Virginia Health System (R.J.S.), Charlottesville, Virginia 22903.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Stuenkel
authors.affiliation: University of California, San Diego, Endocrine/Metabolism (C.A.S.), La Jolla, California 92093; Monash University, School of Public Health and Preventive Medicine (S.R.D.), Melbourne 03004, Australia; Université Paris Descartes, Hôpitaux Universitaires Port Royal-Cochin Unit de Gynécologie Endocrnienne (A.G.), Paris 75014, France; University of Glasgow School of Medicine (M.A.L.), Glasgow G31 2ER, Scotland; Mayo Clinic, Division of Preventive Medicine (M.H.M.), Rochester, Minnesota 55905; University of Virginia, Obstetrics and Gynecology (J.V.P.), Charlottesville, Virginia 22908; and University of Virginia Health System (R.J.S.), Charlottesville, Virginia 22903.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Davis
authors.affiliation: University of California, San Diego, Endocrine/Metabolism (C.A.S.), La Jolla, California 92093; Monash University, School of Public Health and Preventive Medicine (S.R.D.), Melbourne 03004, Australia; Université Paris Descartes, Hôpitaux Universitaires Port Royal-Cochin Unit de Gynécologie Endocrnienne (A.G.), Paris 75014, France; University of Glasgow School of Medicine (M.A.L.), Glasgow G31 2ER, Scotland; Mayo Clinic, Division of Preventive Medicine (M.H.M.), Rochester, Minnesota 55905; University of Virginia, Obstetrics and Gynecology (J.V.P.), Charlottesville, Virginia 22908; and University of Virginia Health System (R.J.S.), Charlottesville, Virginia 22903.
authors.forename: Anne
authors.initials: A
authors.lastname: Gompel
authors.affiliation: University of California, San Diego, Endocrine/Metabolism (C.A.S.), La Jolla, California 92093; Monash University, School of Public Health and Preventive Medicine (S.R.D.), Melbourne 03004, Australia; Université Paris Descartes, Hôpitaux Universitaires Port Royal-Cochin Unit de Gynécologie Endocrnienne (A.G.), Paris 75014, France; University of Glasgow School of Medicine (M.A.L.), Glasgow G31 2ER, Scotland; Mayo Clinic, Division of Preventive Medicine (M.H.M.), Rochester, Minnesota 55905; University of Virginia, Obstetrics and Gynecology (J.V.P.), Charlottesville, Virginia 22908; and University of Virginia Health System (R.J.S.), Charlottesville, Virginia 22903.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Lumsden
authors.affiliation: University of California, San Diego, Endocrine/Metabolism (C.A.S.), La Jolla, California 92093; Monash University, School of Public Health and Preventive Medicine (S.R.D.), Melbourne 03004, Australia; Université Paris Descartes, Hôpitaux Universitaires Port Royal-Cochin Unit de Gynécologie Endocrnienne (A.G.), Paris 75014, France; University of Glasgow School of Medicine (M.A.L.), Glasgow G31 2ER, Scotland; Mayo Clinic, Division of Preventive Medicine (M.H.M.), Rochester, Minnesota 55905; University of Virginia, Obstetrics and Gynecology (J.V.P.), Charlottesville, Virginia 22908; and University of Virginia Health System (R.J.S.), Charlottesville, Virginia 22903.
authors.forename: M Hassan
authors.initials: MH
authors.lastname: Murad
authors.affiliation: University of California, San Diego, Endocrine/Metabolism (C.A.S.), La Jolla, California 92093; Monash University, School of Public Health and Preventive Medicine (S.R.D.), Melbourne 03004, Australia; Université Paris Descartes, Hôpitaux Universitaires Port Royal-Cochin Unit de Gynécologie Endocrnienne (A.G.), Paris 75014, France; University of Glasgow School of Medicine (M.A.L.), Glasgow G31 2ER, Scotland; Mayo Clinic, Division of Preventive Medicine (M.H.M.), Rochester, Minnesota 55905; University of Virginia, Obstetrics and Gynecology (J.V.P.), Charlottesville, Virginia 22908; and University of Virginia Health System (R.J.S.), Charlottesville, Virginia 22903.
authors.forename: JoAnn V
authors.initials: JV
authors.lastname: Pinkerton
authors.affiliation: University of California, San Diego, Endocrine/Metabolism (C.A.S.), La Jolla, California 92093; Monash University, School of Public Health and Preventive Medicine (S.R.D.), Melbourne 03004, Australia; Université Paris Descartes, Hôpitaux Universitaires Port Royal-Cochin Unit de Gynécologie Endocrnienne (A.G.), Paris 75014, France; University of Glasgow School of Medicine (M.A.L.), Glasgow G31 2ER, Scotland; Mayo Clinic, Division of Preventive Medicine (M.H.M.), Rochester, Minnesota 55905; University of Virginia, Obstetrics and Gynecology (J.V.P.), Charlottesville, Virginia 22908; and University of Virginia Health System (R.J.S.), Charlottesville, Virginia 22903.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Santen
mesh_terms: D000367:Age Factors; D001943:Breast Neoplasms / Q000453:epidemiology / Q000517:prevention & control; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control; D000075202:Contraindications; D015914:Estrogen Replacement Therapy / Q000009:adverse effects; D019317:Evidence-Based Medicine; D005260:Female; D052776:Female Urogenital Diseases / Q000188:drug therapy* / Q000503:physiopathology; D019584:Hot Flashes / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008593:Menopause; D057285:Precision Medicine; D012307:Risk Factors; D012720:Severity of Illness Index; D009626:Terminology as Topic; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000517:prevention & control