Benefits, Harms, and Costs
- 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).
- 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).
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)
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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.