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
- 1Low sexual desire in combination with distress is most common in women in mid-life (high).
- 2Vaginal atrophy is a common cause of sexual pain in menopausal women (high).
- 3Sexual dysfunction in menopausal women can be categorized as disorders involving desire, arousal, pain, and orgasm. These categories often overlap (high).
- 4A brief sexual history is part of the evaluation of menopausal women (moderate).
- 5The treatment of sexual dysfunctions involves a multifaceted approach that addresses medical, psychological, and relationship issues (high).
- 6Local estrogen therapy treats genitourinary syndrome of menopause (high).
- 7Pelvic physiotherapy is an excellent adjuvant treatment for hypercontracted pelvic floor muscles (often referred to as vaginismus) and genito-pelvic pain (low).
- 8Flibanserin has been shown to improve desire in women (moderate).
- 9Transdermal testosterone has been shown to increase desire, arousal, and satisfying sexual events, and to decrease personal distress (high).
- 10Psychological therapies, including cognitive behavioural therapy, mindfulness-based therapy, couples’ therapy, and sexual therapies, are useful for treating sexual dysfunctions (moderate).
- 11Sexual dysfunction is common in patients with depression, those on selective serotonin reuptake inhibitors (SSRIs), women with primary ovarian insufficiency, and those with a history of breast cancer (high).
RECOMMENDATIONS
- 1The patient's problem should be categorized as related to desire, arousal, pain, or orgasm, in order to facilitate treatment and to triage care (strong, moderate).
- 2Health care providers should include a sexual screening history and physical examination in the initial evaluation of menopausal women (strong, low).
- 3Vaginal estrogens, lubricants and moisturizers, vaginal dehydroepiandrosterone, and ospemifene may be used as treatments for vaginal atrophy related to menopause (strong, high).
- 4For postmenopausal women with hypoactive sexual desire disorder, the best current options include managing pain, addressing any biopsychological factors, counselling, and prescribing transdermal testosterone (off-label) or flibanserin (strong, moderate).
- 5Patients with breast cancer and symptomatic genitourinary syndrome of menopause can be offered local vaginal estrogen if local lubricants and moisturizers are ineffective, after consulting with the patient's oncologist (conditional, moderate).
Keywords
ABBREVIATIONS:
DHEA (dehydroepiandrosterone), FSAD (female sexual arousal disorder), GSM (genitourinary syndrome of menopause), PLISSIT (Permission, Limited Information, Specific Suggestions, and Intensive Therapy), HSDD (hypoactive sexual desire disorder), SSRI (selective serotonin reuptake inhibitors)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 15, 2021
No. 422d, 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 healthcare 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.
