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 effects of estrogen deficiency on urogenital tissues include signs and symptoms of vulvovaginal atrophy, urinary urgency, dysuria, and recurrent urinary tract infection (high).
- 2Genitourinary syndrome of menopause is common and impairs quality of life, sexual function, and partner relationships (high).
- 3Without treatment, this syndrome will evolve chronically in most women and progress to functional and structural urogenital tissue changes that can be difficult to reverse even with treatment (high).
RECOMMENDATIONS
- 1Women entering menopause should be educated about the progressive impact of estrogen deficiency on urogenital health and the many options available for symptom relief (strong, high).
- 2Menopausal women should be comprehensively screened for genitourinary syndrome of menopause symptoms on an ongoing basis, as symptoms can present insidiously and become bothersome long after the menopausal transition (strong, high).
- 3First-line management options for genitourinary syndrome of menopause may include vaginal lubricants and/or vaginal moisturizers, particularly if patient concerns are limited to vaginal dryness or dyspareunia (strong, high).
- 4Second-line therapy for genitourinary syndrome of menopause is vaginal estrogen, administered either as a cream, tablet, or sustained-release ring (strong, high). Clinically significant systemic hormone absorption does not occur with low-dose therapy, so concomitant progestogen therapy is not needed (strong, high).
- 5Other second-line pharmacotherapy for atrophic vaginal symptoms includes the oral selective estrogen receptor modulator, ospemifene, and vaginal dehydroepiandrosterone ovules (strong, high).
- 6Long-term use of intravaginal laser therapy to manage genitourinary syndrome of menopause or stress urinary incontinence remains experimental and should be conducted only within the protocols of well-executed clinical trials designed to establish its safety and efficacy (strong, very low).
Keywords
ABBREVIATIONS:
CEE (conjugated equine estrogens), DHEA (dehydroepiandrosterone), GSM (genitourinary syndrome of menopause), UTI (urinary tract infection), DEFINITION (Genitourinary syndrome of menopause is a term recently adopted to comprehensively describe the effects of estrogen deficiency on the urogenital tissues. It includes the symptoms and signs of vulvovaginal atrophy, dyspareunia related to atrophy/dryness, overactive bladder, dysuria and recurrent urinary tract infections.)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 07, 2021
No. 422b, November 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.
