Preamble

PREAMBLE PREAMBLE

Preamble enopause is a critical phase in the lives of women. It evokes discussion, controversy, and concern among women and their health care providers about how best to deal with acute symptoms and what changes or interventions are best for optimization of long-term health. In 2009, as the largest demographic from the “baby-boomer” generation reaches age 50 years, we will begin a period of historic demand for menopausal counselling.

M

Women entering menopause are highly motivated to make changes to optimize their health. Thus, health care providers have a unique opportunity to review a woman’s lifestyle Abbreviations Used in This Guideline BMD

bone mineral density

BMI

body mass index

CAD

coronary artery disease

CEE

conjugated equine estrogens

CI

confidence interval

CRP

C-reactive protein

CVD

cardiovascular disease

HABITS

hormonal replacement therapy after breast cancer— Is it safe?

HERS

Heart and Estrogen/progestin Replacement Study

HR

hazard ratio

HT

hormone therapy

IMT

intima–media thickness

MORE

Multiple Outcomes of Raloxifene Evaluation

MPA

medroxyprogesterone acetate

OR

odds ratio

RCT

randomized controlled trial

RR

relative risk

SERM

selective estrogen-receptor modulator

SNRI

serotonin–norepinephrine reuptake inhibitor

SSRI

selective serotonin reuptake inhibitor

STAR

Study of Tamoxifen and Raloxifene

WHI

Women’s Health Initiative

WHIMS

Women’s Health Initiative Memory Study

WISDOM Women’s International Study of long Duration Oestrogen after Menopause

S4

l JANUARY JOGC JANVIER 2009

choices and medical options and to make recommendations that will maintain or improve her quality of life. This opportunity requires that health care providers avail themselves of the available scientific information on aging and familiarize themselves with the emerging information. The appropriateness of offering HT as an option to menopausal women has come under the spotlight with conflicting reports of benefits and risks and confusion about how these compare. This document will provide the reader with an update about the controversies surrounding HT for menopausal women and will try to bring balance and perspective to the risks and benefits to facilitate informed discussion about this option. In 2006, the SOGC published a detailed update from the Canadian Consensus Conference on Menopause that highlighted recommendations for counselling and care of menopausal women.1 Few of these recommendations have changed, although new data have allowed some additional insights, which are reflected in the recommendations of the current report. The current consensus document was developed after a detailed review of publications pertaining to menopause, osteoporosis, and postmenopausal HT. Published literature was identified through searching PubMed (up until February 7, 2008) and the databases of the Cochrane Library (issue 1, 2008), with the use of a combination of controlled vocabulary (e.g., Hormone Replacement Therapy, Cardiovascular Diseases, Mental Health) and key words (e.g., hormone replacement therapy, coronary heart disease, mental well-being). Research-design filters for systematic reviews, randomized and controlled clinical trials, and observational studies were applied to all PubMed searches. Results were limited to publication years 2002 to 2008; there were no language restrictions. Additional information was sought in BMJ Clinical Evidence, in guidelines collections, and from the Websites of major obstetric and gynaecologic associations world wide. REFERENCE 1. Bélisle S, Blake J, Basson R, Desindes S, Graves G, Grigoriadis S, et al. Canadian Consensus Conference on Menopause, 2006 update. J Obstet Gynaecol Can 2006;28(2 Suppl 1):S1-S112.