New menopause guideline addresses conflicting messaging

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) has published guidance on assessing and treating two of the most common symptom groups.

The Management of Vasomotor and Genitourinary Symptoms of Menopause guideline (C-Gyn 9) aims to assist doctors to provide consistency in care in an area is often filled with conflicting messages.

It aims to provide a reliable resource to inform shared decision-making about treatment options.

It focuses on vasomotor symptoms, which include hot flushes and night sweats, and genitourinary symptoms, which include vaginal dryness, burning, irritation, discomfort or pain with sex, and urinary changes such as urgency, pain or recurrent urinary tract infections.

According to a RANZCOG podcast which distils key takeaways from the guideline, the document replaces the College's previous guideline on managing menopausal symptoms.

Gynaecologist Dr Catriona Melville, chair of the menopause guideline development group, said menopausal hormone therapy (MHT) remained the most effective treatment for vasomotor symptoms.

“We do make a strong recommendation that MHT should be offered to women who don’t have contraindications following an individual discussion about the benefits and risk,” she said.

Dr Melville said the guideline goes further by looking at long term risks and benefits.

“For example, looking at venous thromboembolism which we know is increased with oral MHT, however transdermal does not seem to convey that same risk,” she said.

“The guideline is very clear in that we do not recommend MHT for women with current or past breast cancer. However women who are high risk, including those who have had BRCA1 and BRCA2 genetic mutations but don’t have a personal history of breast cancer and have had risk reduction bilateral sinusotomy surgery, they should be offered MHT until the age of normal menopause."

Dr Anita Muñoz, a medical educator who is also featured on the podcast, said one of the key takeaways for general practice was about opening a line of dialogue about menopause with their patients.

“You can’t have a conversation about a condition and you can’t give recommendations about a condition that women don’t know about," she said.

"I think even before people start to complain about symptoms, one of the roles of a general practitioner is to let a woman know as she is progressing towards middle life that there is a symptom check list - awareness is always a starting point.

"Invite women and make them feel comfortable that they can come in at any time if they are starting to become aware that symptoms are declaring themselves. If we wait for women to come in with symptoms off their own bat then we’re potentially missing a lot of conversations."

Muñoz said it was up to those who work in the area to help women break the ice to talk about areas they may be reluctant to talk about, such as genital urinary health.

“This guideline makes it clear that there is a lot you can do about genital urinary symptoms as well as the vasomotor symptoms,” Dr Muñoz said.

RANZCOG said while the guideline does not seek to address every aspect of menopause care, within its defined scope of vasomotor and genitourinary symptoms it represents a robust, evidence-based clinical resource.

The College is also set to be involved in the development of the comprehensive national guidelines for perimenopause and menopause, funded by the federal government.

Alongside the guideline itself, and the podcast episode, RANZCOG has released a quick reference guide for clinicians, including prescribing tables and a patient information pamphlet.