ICSI - Menopause and Hormone Therapy (HT): Collaborative Decision-Making and Management (Guideline)

Menopause and Hormone Therapy (HT): Collaborative Decision-Making and Management (Guideline)

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Scope and Target Population:
The target population for this guideline includes all women interested in discussing midlife health issues, with particular emphasis on women seeking advice about menopausal symptom relief and women currently or recently using hormone therapy (HT).
This guideline focuses on the management of symptoms and conditions commonly associated with menopause, with particular emphasis on the role of HT relative to other options. The ongoing care of women who are currently using or have recently discontinued HT is also emphasized. Many medical conditions are more common or first become apparent in the menopausal age group but are not directly related to menopause and are discussed in other ICSI guidelines.

Clinical Highlights for Individual Clinicians:

There are many effective options to be considered for the relief of menopausal symptoms; although HT is often the most effective treatment, it is not always necessary.

Periodically reevaluate women on HT to determine if it is still indicated, particularly if there have been changes in their health status.

Women who have recently discontinued HT are at risk for rapid bone loss; they must be identified and monitored appropriately to ensure continued bone health.

At this time, the role of HT in disease prevention continues to evolve

The well-publicized results of several clinical trials resulted in increased apprehension about HT among both patients and providers.

The exact risks associated with HT, as well as possible side effects, may not be fully defined, but they cannot be dismissed and must always be considered and discussed as part of the collaborative decision-making process.

Careful consideration and in-depth discussion are required whenever the initiation or continuation of hormone therapy is considered; help each woman clarify her individual values and priorities so that she may decide how important each of the potential benefits and risks of HT is to her unique situation.

Provide support and encouragement, through accessibility and close follow-up, for women who have recently initiated hormone therapy.

Priority Aims:
Increase the percentage of perimenopausal/menopausal women who receive education describing risks, benefits and side effects of HT.

Increase the percentage of women with appropriate follow-up after cessation of HT.