Counseling in menopausal women: How to address the benefits and risks of menopause hormone therapy. A FIGO position paper

Authors

  • AR Genazzani University of Pisa
  • H Divakar Divakars Speciality Hospital
  • SS Khadilkar Well Woman Health Care
  • P Monteleone Azienda USL Toscana Nord Ovest
  • B Evangelisti Sant'Anna University Hospital
  • AF Galal Well Woman Health Care
  • PIR Priego Well Woman Health Care
  • T Simoncini University of Pisa
  • A Giannini University of Pisa
  • G Goba Well Woman Health Care
  • C Benedetto Well Woman Health Care

Keywords:

bioidentical hormones, counseling, hormone therapy, menopausal hormone therapy benefits, menopausal hormone therapy regimens, menopausal hormone therapy risks, menopausal symptoms, menopause

Abstract

Menopause marks the end of menstrual cyclicity and, depending on individual vulnerability, has several consequences related to gonadal steroid deprivation, especially if it is premature. Menopause may be more burdensome for some women than for others. Individual factors, such as personal history, socioeconomic status, ethnicity, and current health conditions, affect symptomatology and, thereby, the menopausal experience. In addition, some menopausal symptoms, such as severe hot flashes, sleep disorders, and depression, are markers of future health risks. Counseling is a fundamental part of health care in the peri- and postmenopause periods. It must include an assessment of the patient's symptoms, needs, desires, and risk profile to address the benefits and risks of menopausal hormone therapy (MHT) on an individual basis and promote a healthy lifestyle. Indeed, healthcare practitioners can and must protect the health and lives of mid-life women by increasing awareness of menopausal symptoms and ensuring healthcare options, especially MHT. The type and duration of MHT should be tailored based on the patient's history, menopausal age, physical characteristics, and current health status so that the benefits always outweigh the risks. This FIGO position paper focuses on the benefits and risks of MHT on health domains, target organs, and systems, and on systemic and vaginal MHT regimens, to provide indications that can be used in the clinical practice for menopausal counseling. Moreover, it offers insights into what FIGO considers the mainstay for the healthcare management of women in peri- and postmenopause, worldwide.

Author Biographies

AR Genazzani, University of Pisa

Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, The University of Pisa, Italy

H Divakar, Divakars Speciality Hospital

Obstetrics and Gynaecology, Divakars Speciality Hospital, India and FIGO Committee on Well Woman Health Care, United Kingdom

SS Khadilkar, Well Woman Health Care

FIGO Committee on Well Woman Health Care, United Kingdom and Department of Obstetrics and Gynecology, Bombay Hospital Institute of Medical Sciences, India

P Monteleone, Azienda USL Toscana Nord Ovest

Division of Obstetrics and Gynecology, Azienda USL Toscana Nord Ovest, Italy

B Evangelisti, Sant'Anna University Hospital

Department of Obstetrics and Gynecology, Sant'Anna University Hospital, Italy

AF Galal, Well Woman Health Care

FIGO Committee on Well Woman Health Care, United Kingdom and Department of Obstetrics and Gynecology, Elshatby Maternity University Hospital, Egypt

PIR Priego, Well Woman Health Care

FIGO Committee on Well Woman Health Care, United Kingdom and Hospital √Āngeles del Pedregal, Mexico

T Simoncini, University of Pisa

Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, The University of Pisa, Italy

A Giannini, University of Pisa

Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, The University of Pisa, Italy

G Goba, Well Woman Health Care

FIGO Committee on Well Woman Health Care, United Kingdom and Department of Obstetrics and Gynecology, University of Illinois, United States of America

C Benedetto, Well Woman Health Care

FIGO Committee on Well Woman Health Care, United Kingdom and Department of Obstetrics and Gynecology, Sant'Anna University Hospital, Italy

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Published

2024-04-12

Issue

Section

Review