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Systematic review
A systematic review and critical appraisal of menopause guidelines
  1. Chandima Hemachandra1,
  2. Sasha Taylor1,
  3. Rakibul M Islam1,
  4. Ensieh Fooladi2,
  5. Susan R Davis1,3
  1. 1 Women's Health Research Program, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
  2. 2 Monash School of Nursing and Midwifery, Clayton, Victoria, Australia
  3. 3 Endocrinology and Diabetes, Alfred Health, Melbourne, Victoria, Australia
  1. Correspondence to Professor Susan R Davis, Women's Health Research Program, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia; susan.davis{at}monash.edu

Abstract

Objective and rationale To identify and appraise current national and international clinical menopause guidance documents, and to extract and compare the recommendations of the most robust examples.

Design Systematic review.

Data sources Ovid MEDLINE, EMBASE, PsycINFO and Web of Science

Eligibility criteria for selecting studies Practice guidance documents for menopause published from 2015 until 20 July 2023. Quality was assessed by the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument.

Results Twenty-six guidance papers were identified. Of these, five clinical practice guidelines (CPGs) and one non-hormonal therapy position statement met AGREE II criteria of being at least of moderate quality. The five CPGs listed symptoms associated with the perimenopause and menopause to be vasomotor symptoms (VMS), disturbed sleep, musculoskeletal pain, decreased sexual function or desire, and mood disturbance (low mood, mood changes or depressive symptoms). Acknowledged potential long-term menopause consequences were urogenital atrophy, and increased risks of cardiovascular disease and osteoporosis. VMS and menopause-associated mood disturbance were the only consistent indications for systemic menopausal hormone therapy (MHT). Some CPGs supported MHT to prevent or treat osteoporosis, but specific guidance was lacking. None recommended MHT for cognitive symptoms or prevention of other chronic disease. Perimenopause-specific recommendations were scant. A neurokinin 3B antagonist, selective serotonin/norepinephrine (noradrenaline) reuptake inhibitors and gabapentin were recommended non-hormonal medications for VMS, and cognitive behavioural therapy and hypnosis were consistently considered as being of potential benefit.

Discussion The highest quality CPGs consistently recommended MHT for VMS and menopause-associated mood disturbance, whereas clinical depression or cognitive symptoms, and cardiometabolic disease and dementia prevention were not treatment indications. Further research is needed to inform clinical recommendations for symptomatic perimenopausal women.

  • Reproductive Medicine
  • menopause
  • Health Policy

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/bmjsrh-2023-202099

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • CH and ST are joint first authors.

    • Contributors SRD: study design; data interpretation; wrote the drafts and guided the development of the manuscript,

      ; manuscript review and revision review; full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish. ST: data acquisition (literature search and data collection); data interpretation; wrote the drafts; manuscript review and revision review. CH: data acquisition (literature search and data collection); data analysis; data interpretation; wrote the drafts; manuscript review and revision review. RMI: study design; data acquisition (literature search); data analysis; data interpretation; manuscript review and revision review. EF: data analysis; data interpretation; manuscript review and revision review.

    • Funding This research was funded by the Australian National Health and Medical Research Council (NHMRC) (Grant 2015514). SRD holds an NHMRC Leadership Grant (2016627)

    • Competing interests SRD reports honoraria from Besins Healthcare, Abbott Healthcare, Mayne Pharma, Health Ed, BioSyent, Lawley Pharmaceuticals and Que Oncology. She has served on advisory boards for Mayne Pharma, Astellas Pharmaceuticals, Besins Healthcare, Theramex and Gedeon Richter, and has been an institutional investigator for Que Oncology and Ovoca Bio.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.