The companyà north American Menopause (NAMS) has published a compilation of key points and recommendations of clinical care to address the myriad of problems facing the women of the half età.
Published in the October issue of Menopause, the Recommendations of the NAMS for the clinical Care of women half età have been compiled by the Working Group in celebration of the 25th anniversary of the NAMS. Will be available for free on the Web Site of the NAMS.
“We are very excited for the 25th birthday of the NAMS, and we thought there was no better way to advance our mission, which summarize the recommendations for the care of the women of the half età in a publication that is concise, based on evidence that is freely available to all,” she told Medscape Medical News Jan L. Shifren, author, leader of the recommendations, and the president of NAMS. “We hope that these recommendations educheranno the doctors and will result in improved care for the women in this complex phase of life.” Dr. Shifren is also a gynaecologist practicing at the Massachusetts General Hospital in Boston.
A team of experts in a wide range of fields and has developed the recommendations, which are presented in more extensive detail in the text book NAMS, Menopause Practices: A Clinician’s Guide. The recommendations cover all areas of women’s health in half età, including topics specific to the menopause (vasomotor symptoms, osteoporosis, and health vulvovaginal), così as arguments più general related to sexual function, cognition, cardiovascular health, thyroid disease and cancer.
The authors have given a score to each recommendation depending on the strength of the evidence that supports it to provide doctors with the best evidence at the time. The recommendations of level 1 are based on the best evidence (good and consistent scientific evidence), the recommendations of level 2 are based on scientific evidence is limited or inconsistent, and the recommendations of level 3 are based on consensus and expert opinion.
Together with providing clarity on a number of controversial topics, such as the use of hormone replacement treatment (HRT) in women peri and post menopause, the guidelines include new recommendations on a range of topics.
These include the guide on how to incorporate the 3 products recently approved by the US Food and Drug Administration for use in women of middle age, explained dr. Shifren. These products include the co-receptor modulator-selective estrogen bazedoxifene combined with estrogen conjugate for the treatment of vasomotor symptoms and prevention of osteoporosis in women with the uterus, paroxetine low dose for vasomotor symptoms and ospemifene for dyspareunia.
The guidelines also include recommendations up to date on the use of the hormone replacement treatment (HRT) in post menopausal women based on new data recently published by the initiative of Women’s Health that includes data from both the intervention and post-intervention.
The guidelines provide recommendations distinct for women without a uterus considering therapy oestrogenic alone and for women with the uterus considering the use of therapy with estrogen, more progesterone, said dr. Shifren.
The recommendation are complete, succinct, and evidence-based, and will be of great help to the doctors, told Medscape Medical News Carol L. Kuhle, a physician of the Clinic for Women’s Health, Mayo Clinic, Rochester, Minnesota. The data from the Study and the Kronos on the Early Prevention with Estrogen recently published support the raccomandaziione that lHRT is safe during the menopausal transition, he added.
A key point in the article is that the benefits of HRT for treatment of vasomotor symptoms outweigh the risks for the women selected. “The treatment of symptoms of moderate to severe vasomotor is the primary indication for hormone therapy. The benefits outweigh the risks for most symptomatic women in health più young people of 60 years or within 10 years from the last menstruation,” says the recommendation.
dr. Kuhle has also said that the information provided by the NAMS on the use of HRT in women with primary ovarian insufficiency are important. The recommendations indicate that “Women with primary ovarian insufficiency or premature menopause without contraindications to hormonal therapy should consider the use of hormone therapy or contraceptives, combined estrogen-progesterone up to the age average of the natural menopause (52 years). A duration più long può be considered for symptomatic women.”
“The current evidence on hormone therapy are not meant to be aimed at women with primary ovarian insufficiency, the consideration of the NAMS for hormonal therapy in this group is important,” said dr. Kuhle. “Based on epidemiological studies, the benefits far exceed the risks for hormonal treatment in this population up to the age of the natural menopause.”
dr. Shifren emphasized that clinicians need to individualize the care of the half età for women, recognizing that each woman has different concerns, health problems and risk factors. “The optimal management variesà, based on specific symptoms, personal beliefs and medical history,” he said.
13 October 2014
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