Updated menopause toolkit to help doctors provide better care

An updated toolkit that guides health professionals in treating menopause health issues has been published in an effort to improve care for women globally.

Endorsed by the International, Australasian and British Menopause Societies, the Endocrine Society of Australia and Jean Hailes for Women’s Health, the 2023 practitioner’s toolkit for managing the menopause is designed to be used anywhere in the world.  

The toolkit, published originally in 2014, has been updated with new advice and therapies based on a systematic review of the latest menopause research and best practice.

The new version includes bone health guidance, such as recommendations about when menopause hormone therapies might be needed to prevent bone loss and osteoporosis in asymptomatic women.

The update also incorporates new medications including fezolinetant for hot flushes, ospemifene for painful sex, and vaginal DHEA for vaginal dryness.

First author and Monash University women’s health research programme head professor Susan Davis, who also led development of the toolkit in 2014, said the update included some new therapies but did not support menopause hormone therapies for cognitive symptoms or clinical depression.

“Clinical trials have not shown a benefit of menopause hormone therapies for cognitive function,” she explained.

“The most robust studies have shown it to be no better than placebo.”

She added: “Regarding depression, menopause may cause symptoms such as low mood, anxiety, irritability, and mood swings, but clinical depression needs to be assessed and managed in its own right.

“Menopause might exacerbate underlying depression but should not be assumed to be the cause of clinical depression.”

Davis said the advice was now much clearer around preventing bone loss and fracture.

“To our knowledge this is the only document that provides guidance for using hormone therapy to prevent fracture. Other recommendations have been vague such as ‘can be used to prevent bone loss/fracture’ or ‘use to treat osteopenia’.”

The author said it was important for women to see their GP if they experienced troubling physical or mental health symptoms.

“We have updated this as part of an NHMRC Grant to upskill GPs and to embed the care algorithms into GP practice software in the MenoPROMPT study programme, which aims to improve care for women who need it. This is a very important feature of this update.”

Senior author Dr Rakib Islam, from the Monash University School of Public Health and Preventive Medicine women’s health research programme, said the updates would make a difference for many.

“The 2023 practitioner’s toolkit is the most up-to-date evidence-based practical guidance for health care providers to menopause care globally,” he said.

The paper’s authors said the recommendations needed to be applied in the context of local availability and the cost of investigations and drug therapies.

“Most importantly, the toolkit provides the full spectrum of available options and therefore can be used to support shared decision making, and patient-informed care,” they added.