British Menopause Society tools for clinicians: Progestogens and endometrial protection

Hamoda, Haitham

doi:10.1177/20533691211058030

Cited by 10 publications

(14 citation statements)

References 30 publications

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“…The authors concluded that both 0.25 and 0.5 mg norethrindrone provides adequate protection. A British Menopause Society publication using the same data came to a more conservative recommendation of 0.5 mg norethrindrone 54. In the US, only a 0.35 mg pill is available.…”

Section: Menopausal Hormone Therapymentioning

confidence: 99%

“…One small RCT that randomized women to estradiol 0.05 mg patch with continuous oral micronized progesterone 100 mg or 200 mg or vaginal progesterone 100 mg or 200 mg daily showed no significant differences in endometrial thickness at 12 month follow-up but provided no histologic outcomes. If using micronized progesterone capsules vaginally, equivalent dosing to oral dosing is suggested, even though vaginal absorption and effective dose to the uterus may be higher with this route of administration 54…”

Section: Menopausal Hormone Therapymentioning

confidence: 99%

“…Unscheduled bleeding persisting beyond six months is abnormal. For postmenopausal women on continuous hormone therapy, bleeding persisting beyond six months or beginning after this timeframe is abnormal 1354…”

Section: Treatment Approach By Symptom or Signmentioning

confidence: 99%

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Management of perimenopausal and menopausal symptoms

Duralde

Sobel

Manson

2023

BMJ

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Most women worldwide experience menopausal symptoms during the menopause transition or postmenopause. Vasomotor symptoms are most pronounced during the first four to seven years but can persist for more than a decade, and genitourinary symptoms tend to be progressive. Although the hallmark symptoms are hot flashes, night sweats, disrupted sleep, and genitourinary discomfort, other common symptoms and conditions are mood fluctuations, cognitive changes, low sexual desire, bone loss, increase in abdominal fat, and adverse changes in metabolic health. These symptoms and signs can occur in any combination or sequence, and the link to menopause may even be elusive. Estrogen based hormonal therapies are the most effective treatments for many of the symptoms and, in the absence of contraindications to treatment, have a generally favorable benefit:risk ratio for women below age 60 and within 10 years of the onset of menopause. Non-hormonal treatment options are also available. Although a symptom driven treatment approach with individualized decision making can improve health and quality of life for midlife women, menopausal symptoms remain substantially undertreated by healthcare providers.

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Section: Menopausal Hormone Therapymentioning

confidence: 99%

Section: Menopausal Hormone Therapymentioning

confidence: 99%

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Management of perimenopausal and menopausal symptoms

Duralde

Sobel

Manson

2023

BMJ

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“…Current guidance recommends NET 5 mg is taken for 12 days in sequential HRT regimes and NET 0.5–1 mg is taken daily in continuous HRT regimes. 39 It is estimated that 1 mg of orally administered NET metabolises to 4–6 µg ethinylestradiol. 40 Considering the thromboembolic risk associated with ethinylestradiol, this conversion may be clinically significant in women at increased risk for VTE.…”

Section: Discussionmentioning

confidence: 99%

Exploring the potential for a set of UK hormone replacement therapy eligibility guidelines: A suggested proposal on the topic of venous thromboembolism

Laing,

Thomas,

Hillard

et al. 2023

Post Reprod Health

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Objective To explore the feasibility for a set of hormone replacement therapy (HRT) eligibility guidelines that follow a similar structure and appearance to the UKMEC guidance for contraception. To enable non-specialists to feel confident in safely prescribing HRT and to aid selection of the most appropriate first line treatment. Methods A literature review was undertaken with evidence summarised on the topic of venous thromboembolism (VTE) which is an area frequently considered a barrier to prescribing. Medical eligibility tables which separated HRT by type were then produced for a set of VTE-related topics. Results The literature search confirmed the importance of distinguishing between different types and routes of administration when considering the suitability of HRT. Much of the evidence has been based on older synthetic types of HRT and whilst they still have a role in management, these medications carry different risks to the now more accepted use of body identical types. The search also highlighted the nuances involved, increasing the complexity of forming guidelines, with the need for consideration to be given to an individual’s own perception of risks and benefits. Conclusion The demand for HRT has risen in recent years and there is a need for this to be managed effectively, particularly for patients in primary care. The production of this type of guidance will enable the non-specialist to feel confident in safe and evidence-based prescribing. The guidelines are also designed to demonstrate to prescribers which complex patients should be referred onto menopause specialists.

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“…It can also be considered after 12-18 months of sequential use, if women want to try ccHRT to see if they can achieve a bleed-free regimen at an earlier point. 25 Tricycling (Long-cycle) progestogen use and shortened progestogen regimens. This is where estrogen is given daily but a reduced progestogen course (7-10 days) is given every 3 months.…”

Section: Major Risk Factorsmentioning

confidence: 99%

Management of unscheduled bleeding on HRT: A joint guideline on behalf of the British Menopause Society, Royal College Obstetricians and Gynaecologists, British Gynaecological Cancer Society, British Society for Gynaecological Endoscopy, Faculty of Sexual and Reproductive Health, Royal College of General Practitioners and Getting it Right First Time

Manley,

Hillard,

Clark

et al. 2024

Post Reprod Health

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Unscheduled bleeding on hormone replacement therapy (HRT) can affect up to 40% of users. In parallel with the increase in HRT prescribing in the UK, there has been an associated increase in referrals to the urgent suspicion of cancer pathway for unscheduled bleeding. On behalf of the British Menopause Society (BMS) an expert review panel was established, including primary and secondary care clinicians with expertise in the management of menopause, with representatives from key related organisations, including the Royal College of Obstetricians & Gynaecologists, the British Gynaecological Cancer Society, British Society for Gynaecological Endoscopy, Royal College of General Practitioners and Faculty of Sexual and Reproductive Health, and service development partners from NHS England and GIRFT (Getting it Right First Time). For each topic, a focused literature review was completed to develop evidence led recommendations, where available, which were ratified by consensus review within the panel and by guideline groups.

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British Menopause Society tools for clinicians: Progestogens and endometrial protection

Cited by 10 publications

References 30 publications

Management of perimenopausal and menopausal symptoms

Management of perimenopausal and menopausal symptoms

Exploring the potential for a set of UK hormone replacement therapy eligibility guidelines: A suggested proposal on the topic of venous thromboembolism

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