ABSTRACT
Objective
Provide strategies for improving the care of perimenopausal and postmenopausal women
based on the most recent published evidence.
Target Population
Perimenopausal and postmenopausal women.
Benefits, Harms, and Costs
Target population will benefit from the most recent published scientific evidence
provided via the information from their health care provider. No harms or costs are
involved with this information since women will have the opportunity to choose among
the different therapeutic options for the management of the symptoms and morbidities
associated with menopause, including the option to choose no treatment.
Evidence
Databases consulted were PubMed, MEDLINE, and the Cochrane Library for the years 2002–2020,
and MeSH search terms were specific for each topic developed through the 7 chapters.
Validation Methods
The authors rated the quality of evidence and strength of recommendations using the
Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations).
Intended Audience
physicians, including gynaecologists, obstetricians, family physicians, internists,
emergency medicine specialists; nurses, including registered nurses and nurse practitioners;
pharmacists; medical trainees, including medical students, residents, fellows; and
other providers of health care for the target population.
SUMMARY STATEMENTS
- 1The vast majority of women in mid-life experience menopausal symptoms, the hallmark being vasomotor symptoms. A significant portion of these women have severe symptoms that greatly affect their quality of life (high).
- 2For the management of vasomotor symptoms, menopausal hormone therapy is the most effective option and can be safely initiated in women without contraindications who are younger than 60 years of age or less than 10 years post-menopause (high).
- 3Options for menopausal hormone therapy for vasomotor symptoms in women with a uterus include estrogen-progestogen therapy, a tissue-selective estrogen complex, or tibolone. Estrogen alone can be used in women who have had a hysterectomy (high).
- 4The safety and efficacy of compounded bioidentical hormone therapy have not been assessed with the same rigour as those of menopausal hormone therapy products approved by Health Canada (moderate).
- 5Non-hormonal prescription therapies, including certain antidepressant agents, gabapentinoids, clonidine, and oxybutynin, may offer some relief from hot flashes but have their own adverse effects (moderate).
- 6There is emerging evidence that cognitive behavioural therapy may have positive effects on vasomotor symptoms (high).
- 7There is insufficient evidence to support the effectiveness of any one natural health product for the management of moderate to severe hot flashes (low).
- 8A healthy diet during menopause can reduce the risk of future chronic conditions, aid in weight management, and improve energy levels (high).
RECOMMENDATIONS
- 1Health care providers should offer menopausal hormone therapy as the most effective option for managing vasomotor symptoms (strong, high).
- 2Menopausal hormone therapy can be safely initiated in women without contraindications who are younger than 60 years of age or less than 10 years post-menopause (strong, high).
- 3Menopausal hormone therapy should be individualized after careful consideration of symptoms, medical conditions, health risks, family history, treatment goals, patient preferences, and timing of last menstrual period (strong, high).
- 4Duration of menopausal hormone therapy should be individualized to the patient, based on ongoing symptoms, benefits, and personal risks. Periodic re-evaluation of menopausal hormone therapy is recommended (strong, high).
- 5Women who have experienced loss of ovarian function or with decreased ovarian function before the age of 45 years should consider replacement hormone therapy until the average age of menopause (strong, high).
- 6Estrogen-progestogen regimens can be continuous (i.e., estrogen-progestogen taken every day) or follow a cyclic regimen, with estrogen taken every day and progestogen taken for 12–14 days every month. In women with hysterectomy, estrogen alone can be taken every day (strong, high).
- 7Options for perimenopausal women include progestogen alone, low-dose combined hormonal contraceptives, menopausal hormone therapy, or estrogen in combination with a levonorgestrel-releasing intrauterine system. (strong, moderate)
- 8Non-hormonal prescription therapies can be considered when hormone therapy is contraindicated or not desired (strong, moderate).
- 9For cultural traditional therapies, women should be offered the opportunity to work with a cultural leader; health care providers can discuss this option in partnership with women, in order to ensure cultural humility and cultural safety (strong, moderate).
Keywords
Abbreviations:
BHT (bioidentical hormone therapy), CBT (cognitive behavioural therapy), DHEA (dehydroepiandrosterone), EPT (estrogen-progestogen therapy), ER (estrogen receptor), GSM (genitourinary syndrome of menopause), LNG-IUS (levonorgestrel intrauterine system), MHT (menopausal hormone therapy), NHP (natural health products), SERM (selective estrogen receptor modulator), SNRI (serotonin-norepinephrine uptake inhibitor), SSRI (selective serotonin reuptake inhibitor), TSEC (tissue selective estrogen complex), VMS (vasomotor symptoms)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Obstetrics and Gynaecology CanadaAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The menopausal hot flush: A review.Climacteric. 2017; 20: 296-305
- Vasomotor symptoms and menopause: Findings from the study of women's health across the nation.Obstet Gynecol Clin North Am. 2011; 38: 489-501
- Abdominal adiposity and hot flashes among midlife women.Menopause. 2008; 15: 429-434
- Prevalence of hot flushes and night sweats around the world: A systematic review.Climacteric. 2007; 10: 197-214
- Menopausal hot flushes and night sweats: Where are we now?.Climacteric. 2011; 14: 515-528
- Duration of menopausal vasomotor symptoms over the menopause transition.JAMA Intern Med. 2015; 175: 531-539
- Characterizing the trajectories of vasomotor symptoms across the menopausal transition.Menopause. 2016; 23: 1067-1074
- Pathophysiology and treatment of menopausal hot flashes.Semin Reprod Med. 2005; 23: 117-125
- Neurokinin 3 receptor antagonism: A novel treatment for menopausal hot flushes.Neuroendocrinology. 2019; 109: 242-248
- More promising news (mostly) on manipulating neurokinin b activity as a nonhormonal treatment of hot flashes.Menopause. 2020; 27: 375-376
- Neurokinin 3 receptor antagonists for treatment of vasomotor symptoms: A new panacea or just a flash in the pan?.Menopause. 2018; 25: 859-861
- Effects of nt-814, a dual neurokinin 1 and 3 receptor antagonist, on vasomotor symptoms in postmenopausal women: A placebo-controlled, randomized trial.Menopause. 2020; 27: 498-505
- Vasomotor symptoms: Natural history, physiology, and links with cardiovascular health.Climacteric. 2018; 21: 96-100
- Menopausal hot flashes and carotid intima media thickness among midlife women.Stroke. 2016; 47: 2910-2915
- Menopausal symptoms: Comparative effectiveness of therapies. Ahrq comparative effectiveness reviews.Rockville (MD). 2015;
- Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes.Cochrane Database Syst Rev. 2004; CD002978
- Hormone therapy for preventing cardiovascular disease in post-menopausal women.Cochrane Database Syst Rev. 2015; CD002229
- Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the women's health initiative randomized trials.JAMA. 2013; 310: 1353-1368
- Bayesian meta-analysis of hormone therapy and mortality in younger postmenopausal women.Am J Med. 2009; 122 (1016-22 e1)
- Clinical features of young women with hypergonadotropic amenorrhea.Fertil Steril. 1990; 53: 804-810
- Oral micronized progesterone for vasomotor symptoms–a placebo-controlled randomized trial in healthy postmenopausal women.Menopause. 2012; 19: 886-893
- Oral medroxyprogesterone in the treatment of postmenopausal symptoms.JAMA. 1980; 244: 1443-1445
- Extended duration use of menopausal hormone therapy.Menopause. 2014; 21: 679-681
- The North American Menopause Society statement on continuing use of systemic hormone therapy after age 65.Menopause. 2015; 22: 693
- Accelerated accumulation of multimorbidity after bilateral oophorectomy: A population-based cohort study.Mayo Clin Proc. 2016; 91: 1577-1589
- Increased cardiovascular mortality after early bilateral oophorectomy.Menopause. 2009; 16: 15-23
- Increased risk of cognitive impairment or dementia in women who underwent oophorectomy before menopause.Neurology. 2007; 69: 1074-1083
- Long-term impacts of early and surgical menopause.Menopause. 2012; 19: 253-254
- Gradual discontinuation of hormone therapy does not prevent the reappearance of climacteric symptoms: A randomized prospective study.Menopause. 2006; 13: 370-376
- A randomized controlled study of taper-down or abrupt discontinuation of hormone therapy in women treated for vasomotor symptoms.Menopause. 2010; 17: 72-79
- The impact of micronized progesterone on the endometrium: A systematic review.Climacteric. 2016; 19: 316-328
- Effects of various types and dosages of progestogens on the postmenopausal endometrium.J Reprod Med. 1982; 27: 539-548
- Combined continuous hormone replacement therapy: A critical review.Obstet Gynecol. 1995; 86: 306-316
- Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence.Lancet. 2019; 394: 1159-1168
- Menopause: Diagnosis and management.2015 (Available at)https://www.nice.org.uk/guidance/ng23/resources/menopause-diagnosis-and-management-pdf-1837330217413(Accessed: August 4, 2021)
Menopause practice: A clinician's guide, 6th ed. The North American Menopause Society. Available at http://www.menopause.org/publications/professional-publications/em-menopause-practice-em-textbook. Accessed: August 4, 2021.
- Guideline no. 422e: Menopause and cardiovascular disease.J Obstet Gynaecol Can. 2021; 43 (In Press)
- Chapter 44: Estrogens, progestins, and the female reproductive tract.in: Brunton LL Hilal-Dandan R Knollmann BC Goodman & gilman's: The pharmacological basis of therapeutics, 13e. McGraw-Hill Education, New York, NY2017
- Postmenopausal hormone therapy and risk of idiopathic venous thromboembolism: Results from the E3N cohort study.Arterioscler Thromb Vasc Biol. 2010; 30: 340-345
- The route of administration, timing, duration and dose of postmenopausal hormone therapy and cardiovascular outcomes in women: A systematic review.Hum Reprod Update. 2019; 25: 257-271
- Use of hormone replacement therapy and risk of venous thromboembolism: Nested case-control studies using the qresearch and cprd databases.BMJ. 2019; 364: k4810
- The levonorgestrel-releasing intrauterine system for endometrial protection during estrogen replacement therapy: A clinical review.Climacteric. 2015; 18: 470-482
- Evaluation of bazedoxifene/conjugated estrogens for the treatment of menopausal symptoms and effects on metabolic parameters and overall safety profile.Fertil Steril. 2009; 92: 1025-1038
- Relief of vasomotor symptoms with the tissue-selective estrogen complex containing bazedoxifene/conjugated estrogens: A randomized, controlled trial.Menopause. 2009; 16: 1116-1124
- Breast density changes in a randomized controlled trial evaluating bazedoxifene/conjugated estrogens.Menopause. 2013; 20: 138-145
- Breast effects of bazedoxifene-conjugated estrogens: A randomized controlled trial.Obstet Gynecol. 2013; 121: 959-968
- Bazedoxifene when paired with conjugated estrogens is a new paradigm for treatment of postmenopausal women.Expert Opin Investig Drugs. 2010; 19: 1613-1621
- Effects of bazedoxifene/conjugated estrogens on endometrial safety and bone in postmenopausal women.Climacteric. 2013; 16: 338-346
- Effects of bazedoxifene/conjugated estrogens on the endometrium and bone: A randomized trial.J Clin Endocrinol Metab. 2014; 99: E189-E198
- Tibolone in postmenopausal women: A review based on recent randomised controlled clinical trials.Gynecol Endocrinol. 2010; 26: 804-814
- Short-term and long-term effects of tibolone in postmenopausal women.Cochrane Database Syst Rev. 2016; 10CD008536
- Safety and efficacy of tibolone in breast-cancer patients with vasomotor symptoms: A double-blind, randomised, non-inferiority trial.Lancet Oncol. 2009; 10: 135-146
- Effects of tibolone and continuous combined hormone replacement therapy on mammographic breast density.Am J Obstet Gynecol. 2002; 186: 717-722
Tibella product monograph [June 2020]. Available at https://pdf.hres.ca/dpd_pm/00051104.PDF. Accessed: August 4, 2021.
- Guideline no. 422b: Menopause and genitourinary health.J Obstet Gynaecol Can. 2021; 43 (In press)
- Treatment of pain at sexual activity (dyspareunia) with intravaginal dehydroepiandrosterone (prasterone).Menopause. 2015; 22: 950-963
- Prasterone has parallel beneficial effects on the main symptoms of vulvovaginal atrophy: 52-week open-label study.Maturitas. 2015; 81: 46-56
- Efficacy of intravaginal dehydroepiandrosterone (DHEA) on moderate to severe dyspareunia and vaginal dryness, symptoms of vulvovaginal atrophy, and of the genitourinary syndrome of menopause.Menopause. 2016; 23: 243-256
- Lack of effect of intravaginal dehydroepiandrosterone (DHEA, prasterone) on the endometrium in postmenopausal women.Menopause. 2015; 22: 1289-1295
Intrarosa product monograph [June 2020]. Available at https://fernandlabrie.blob.core.windows.net/media/5025/non-annotated-pm-word_approved.pdf. Accessed: August 4, 2021.
- Efficacy and safety of ospemifene in postmenopausal women with moderate-to-severe vaginal dryness: A phase 3, randomized, double-blind, placebo-controlled, multicenter trial.Menopause. 2019; 26: 611-621
- Ospemifene Study G. Ospemifene effectively treats vulvovaginal atrophy in postmenopausal women: Results from a pivotal phase 3 study.Menopause. 2010; 17: 480-486
- Ospemifene, a novel selective estrogen receptor modulator for treating dyspareunia associated with postmenopausal vulvar and vaginal atrophy.Menopause. 2013; 20: 623-630
- Ospemifene 12-month safety and efficacy in postmenopausal women with vulvar and vaginal atrophy.Climacteric. 2014; 17: 173-182
- Ospemifene for the treatment of vulvar and vaginal atrophy: A meta-analysis of randomized trials. Part ii: Evaluation of tolerability and safety.Maturitas. 2019; 121: 93-100
- Overall safety of ospemifene in postmenopausal women from placebo-controlled phase 2 and 3 trials.J Womens Health (Larchmt). 2018; 27: 14-23
- No increase in incidence or risk of recurrence of breast cancer in ospemifene-treated patients with vulvovaginal atrophy (vva).Maturitas. 2020; 142: 38-44
- Continuation of postmenopausal hormone replacement therapy: Comparison of cyclic versus continuous combined schedules.Menopause. 2018; 25: 1187-1190
- Differential effects of progestogens used for menopausal hormone therapy.Clin Obstet Gynecol. 2018; 61: 454-462
- Disturbances of endometrial bleeding with hormone replacement therapy.Hum Reprod. 2000; 15: 7-17
- Transdermal estradiol and oral or vaginal natural progesterone: Bleeding patterns.Climacteric. 2010; 13: 442-446
- Defining bioidentical hormones for menopause-related symptoms.Pharm Pract (Granada). 2011; 9: 16-22
- Promotion and marketing of bioidentical hormone therapy on the internet: A content analysis of websites.Menopause. 2017; 24: 1129-1135
- Bioidentical hormone therapy: A panacea that lacks supportive evidence.Curr Opin Obstet Gynecol. 2008; 20: 400-407
- National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on the Clinical Utility of Treating Patients with Compounded Bioidentical Hormone Replacement Therapy.in: Jackson LM Parker RM Mattison DR The clinical utility of compounded bioidentical hormone therapy: A review of safety, effectiveness, and use. National Academies Press (US) Copyright 2020 by the National Academy of Sciences. All rights reserved., Washington (DC)2020
- Non-hormonal interventions for hot flushes in women with a history of breast cancer.Cochrane Database Syst Rev. 2010; CD004923
- Nonhormonal therapies for menopausal hot flashes: Systematic review and meta-analysis.JAMA. 2006; 295: 2057-2071
- Problems associated with long-term treatment with selective serotonin reuptake inhibitors.J Psychopharmacol. 2009; 23: 967-974
- Quality of life and the role of menopausal hormone therapy.Climacteric. 2012; 15: 213-216
- Non-hormonal treatment strategies for vasomotor symptoms: A critical review.Drugs. 2011; 71: 287-304
- Low-dose paroxetine 7.5 mg for menopausal vasomotor symptoms: Two randomized controlled trials.Menopause. 2013; 20: 1027-1035
- Paroxetine-the antidepressant from hell? Probably not, but caution required.Psychopharmacol Bull. 2016; 46: 77-104
- Tamoxifen and antidepressant drug interaction in a cohort of 16,887 breast cancer survivors.J Natl Cancer Inst. 2016; 108
- Use of gabapentin in patients experiencing hot flashes.Pharmacotherapy. 2009; 29: 74-81
- Use of gabapentin for the management of natural or surgical menopausal hot flashes.Ann Pharmacother. 2011; 45: 388-394
- Phase III, randomized, double-blind, placebo-controlled evaluation of pregabalin for alleviating hot flashes, n07c1.J Clin Oncol. 2010; 28: 641-647
- Health Canada advises canadians to exercise caution when taking gabapentin or pregabalin with opioids.2019 (Available at) (Accessed: August 4, 2021)
- Extended-release oxybutynin therapy for vasomotor symptoms in women: A randomized clinical trial.Menopause. 2016; 23: 1214-1221
- Oxybutynin vs placebo for hot flashes in women with or without breast cancer: A randomized, double-blind clinical trial (accru sc-1603).JNCI Cancer Spectr. 2020; 4: pkz088
- A systematic review of neurocognitive dysfunction with overactive bladder medications.Int Urogynecol J. 2021;
- Use of complementary and alternative medicine during the menopause transition: Longitudinal results from the study of women's health across the nation.Menopause. 2008; 15: 32-43
- Us women desire greater professional guidance on hormone and alternative therapies for menopause symptom management.Menopause. 2006; 13: 506-516
- Mindfulness, cognitive behavioural and behaviour-based therapy for natural and treatment-induced menopausal symptoms: A systematic review and meta-analysis.BJOG. 2019; 126: 330-339
- Cognitive behavior therapy for menopausal symptoms (CBT-Meno): A randomized controlled trial.Menopause. 2019; 26: 972-980
- Effectiveness of group and self-help cognitive behavior therapy in reducing problematic menopausal hot flushes and night sweats (MENOS 2): A randomized controlled trial.Menopause. 2012; 19: 749-759
- Beliefs about hot flashes drive treatment benefit.Menopause. 2014; 21: 909
- Cognitive behaviour therapy for menopausal symptoms following breast cancer treatment: Who benefits and how does it work?.Maturitas. 2014; 78: 56-61
- Cognitive behaviour therapy for menopausal hot flushes and night sweats: A qualitative analysis of women's experiences of group and self-help cbt.Behav Cogn Psychother. 2013; 41: 441-457
- Randomized trial of a hypnosis intervention for treatment of hot flashes among breast cancer survivors.J Clin Oncol. 2008; 26: 5022-5026
- Clinical hypnosis in the treatment of postmenopausal hot flashes: A randomized controlled trial.Menopause. 2013; 20: 291-298
Government of Canada. About natural health product regulation in Canada. Available at https://www.canada.ca/en/health-canada/services/drugs-health-products/natural-non-prescription/regulation.html. Accessed December 1, 2019.
- Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of the North American Menopause Society.Menopause. 2015; 22 (; quiz 73-4): 1155-1172
- A systematic review of herbal medicinal products for the treatment of menopausal symptoms.Menopause. 2003; 10: 465-476
- Complementary and alternative medicine for menopausal symptoms: A review of randomized, controlled trials.Ann Intern Med. 2002; 137: 805-813
- Phytoestrogens for menopausal vasomotor symptoms.Cochrane Database Syst Rev. 2013; CD001395
- Equol decreases hot flashes in postmenopausal women: A systematic review and meta-analysis of randomized clinical trials.J Med Food. 2019; 22: 127-139
Government of Canada. Canada's food guide. Available at https://food-guide.canada.ca/en/. Accessed: August 4, 2021.
Dietitians of Canada. Female nutrition Available at https://www.dietitians.ca/Dietitians-Views/Specific-Populations/Female-Nutrition.aspx. Accessed June 1, 2020.
- Canadian consensus on female nutrition: Adolescence, reproduction, menopause, and beyond.J Obstet Gynaecol Can. 2016; 38 (508-54 e18)
- Sedentary lifestyle and high-carbohydrate intake are associated with low-grade chronic inflammation in post-menopause: A cross-sectional study.Rev Bras Ginecol Obstet. 2016; 38: 317-324
- Dietary factors and female breast cancer risk: A prospective cohort study.Nutrients. 2017; 9
- Association between dietary inflammatory potential and breast cancer incidence and death: Results from the women's health initiative.Br J Cancer. 2016; 114: 1277-1285
- A low-fat dietary pattern and diabetes: A secondary analysis from the women's health initiative dietary modification trial.Diabetes Care. 2018; 41: 680-687
- Low-fat dietary pattern and breast cancer mortality in the women's health initiative randomized controlled trial.J Clin Oncol. 2017; 35: 2919-2926
- Dietary patterns: From nutritional epidemiologic analysis to national guidelines.Am J Clin Nutr. 2015; 101: 899-900
- Low-fat dietary pattern and cardiovascular disease: Results from the women's health initiative randomized controlled trial.Am J Clin Nutr. 2017; 106: 35-43
- Sodium in Canada.2017 (Available at) (Accessed June 1, 2020)
- Vegetable and fruit intake and fracture-related hospitalisations: A prospective study of older women.Nutrients. 2017; 9
- Associations of protein intake and protein source with bone mineral density and fracture risk: A population-based cohort study.J Nutr Health Aging. 2015; 19: 861-868
- High glycemic index diet as a risk factor for depression: Analyses from the women's health initiative.Am J Clin Nutr. 2015; 102: 454-463
- Greater adherence to the alternative healthy eating index is associated with lower incidence of physical function impairment in the nurses' health study.J Nutr. 2016; 146: 1341-1347
- Are cognitive functions in post-menopausal women related with the contents of macro- and micro-components in the diet?.Ann Agric Environ Med. 2015; 22: 178-184
- Decreased lipogenesis-promoting factors in adipose tissue in postmenopausal women with overweight on a paleolithic-type diet.Eur J Nutr. 2018; 57: 2877-2886
Food and Agriculture Organization of the United Nations. Food-based dietary guidelines - brazil. Available at http://www.fao.org/nutrition/education/food-based-dietary-guidelines/regions/countries/brazil/en/. Accessed June 1, 2020.
- Menopausal hot flashes: A concise review.J Midlife Health. 2019; 10: 6-13
- Exercise for vasomotor menopausal symptoms.Cochrane Database Syst Rev. 2014; CD006108
- Efficacy of yoga for vasomotor symptoms: A randomized controlled trial.Menopause. 2014; 21: 339-346
- Effectiveness of yoga for menopausal symptoms: A systematic review and meta-analysis of randomized controlled trials.Evid Based Complement Alternat Med. 2012; 2012863905
- An intensive behavioral weight loss intervention and hot flushes in women.Arch Intern Med. 2010; 170: 1161-1167
- Behavioral weight loss for the management of menopausal hot flashes: A pilot study.Menopause. 2015; 22: 59-65
- Mindfulness training for coping with hot flashes: Results of a randomized trial.Menopause. 2011; 18: 611-620
- Paced breathing compared with usual breathing for hot flashes.Menopause. 2013; 20: 179-184
- Effects of applied relaxation on vasomotor symptoms in postmenopausal women: A randomized controlled trial.Menopause. 2013; 20: 401-408
- Acupuncture for menopausal hot flushes.Cochrane Database Syst Rev. 2013; CD007410
- Efficacy of phytoestrogens for menopausal symptoms: A meta-analysis and systematic review.Climacteric. 2015; 18: 260-269
- Efficacy and safety of standard versus low-dose femarelle (dt56a) for the treatment of menopausal symptoms.Clin Exp Obstet Gynecol. 2004; 31: 123-126
- Effects of red clover on perimenopausal and postmenopausal women's blood lipid profile: A meta-analysis.Climacteric. 2018; 21: 446-453
- Red clover extract: A putative source for simultaneous treatment of menopausal disorders and the metabolic syndrome.Menopause. 2008; 15: 1120-1131
- Controlled flax interventions for the improvement of menopausal symptoms and postmenopausal bone health: A systematic review.Menopause. 2013; 20: 1207-1215
- Black cohosh (Cimicifuga spp.) for menopausal symptoms.Cochrane Database Syst Rev. 2012; CD007244
- Crinum latifolium leave extracts suppress immune activation cascades in peripheral blood mononuclear cells and proliferation of prostate tumor cells.Sci Pharm. 2011; 79: 323-335
- Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial.Fertil Steril. 1997; 68: 981-986
- Complementary and alternative medicine for menopause.J Evid Based Integr Med. 2019; 242515690X19829380
- Ginseng for managing menopause symptoms: A systematic review of randomized clinical trials.J Ginseng Res. 2013; 37: 30-36
- Effects of red ginseng supplementation on menopausal symptoms and cardiovascular risk factors in postmenopausal women: A double-blind randomized controlled trial.Menopause. 2012; 19: 461-466
- The pollen extract femal–a nonestrogenic alternative to hormone therapy in women with menopausal symptoms.Menopause. 2012; 19: 825-829
- Femal, a herbal remedy made from pollen extracts, reduces hot flushes and improves quality of life in menopausal women: A randomized, placebo-controlled, parallel study.Climacteric. 2005; 8: 162-170
- A randomized, double-blind, placebo-controlled, cross-over pilot study on the use of a standardized hop extract to alleviate menopausal discomforts.Phytomedicine. 2010; 17: 389-396
- A first prospective, randomized, double-blind, placebo-controlled study on the use of a standardized hop extract to alleviate menopausal discomforts.Maturitas. 2006; 54: 164-175
- Maca (lepidium meyenii) for treatment of menopausal symptoms: A systematic review.Maturitas. 2011; 70: 227-233
Article info
Publication history
Published online: August 11, 2021
No. 422a, October 2021 (Replaces No. 311, September 2014)Footnotes
This document reflects emerging clinical and scientific advances as of the publication date and is subject to change. The information is not meant to dictate an exclusive course of treatment or procedure. Institutions are free to amend the recommendations. The SOGC suggests, however, that they adequately document any such amendments.
Informed consent: Everyone has the right and responsibility to make informed decisions about their care together with their health care providers. In order to facilitate this, the SOGC recommends that health care providers provide patients with information and support that is evidence-based, culturally appropriate, and personalized.
Language and inclusivity: The SOGC recognizes the importance to be fully inclusive and when context is appropriate, gender-neutral language will be used. In other circumstances, we continue to use gendered language because of our mission to advance women's health. The SOGC recognizes and respects the rights of all people for whom the information in this document may apply, including but not limited to transgender, non-binary, and intersex people. The SOGC encourages health care providers to engage in respectful conversation with their patients about their gender identity and preferred gender pronouns and to apply these guidelines in a way that is sensitive to each person's needs.
Identification
Copyright
© 2021 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Corrigendum to ‘Guideline No. 422a: Menopause: Vasomotor Symptoms, Prescription Therapeutic Agents, Complementary and Alternative Medicine, Nutrition, and Lifestyle’ [J Obstet Gynaecol Can 43 (2021) 1188−1204]Journal of Obstetrics and Gynaecology Canada Vol. 44Issue 2
