• Vasomotor symptoms. In: Menopause and osteoporosis update 2009. J Obstet Gynaecol Can 2009 Jan;31(1 Suppl 1):S9-10. [26 references]

This is the current release of the guideline.

This guideline updates a previous version: Desindes S, Belisle S, Graves G. Menopause and age-related concerns. In: Canadian consensus conference on menopause, 2006 update. J Obstet Gynaecol Can 2006 Feb;28(2 Suppl 1):S21-32. [97 references]

Graves G, Blake J. Specific medical considerations. In: Canadian consensus conference on menopause, 2006 update. J Obstet Gynaecol Can 2006 Feb;28(2 Suppl 1):S75-80. [68 references]

The grades of recommendations (A-E and L) and levels of evidence (I, II-1, II-2, II-3, and III) are defined at the end of the "Major Recommendations" field.

1. Lifestyle modifications, including reducing core body temperature, regular exercise, weight management, smoking cessation, and avoidance of known triggers such as hot drinks and alcohol may be recommended to reduce mild vasomotor symptoms. (IC)
2. Health care providers should offer hormone therapy (HT) (estrogen alone or estrogen and progestogen therapy [EPT]) as the most effective therapy for the medical management of menopausal symptoms. (IA)
3. Progestins alone or low-dose oral contraceptives can be offered as alternatives for the relief of menopausal symptoms during the menopausal transition. (IA)
4. Nonhormonal prescription therapies, including treatment with certain antidepressant agents, gabapentin, clonidine, and bellergal, may afford some relief from hot flashes but have their own side effects. These alternatives can be considered when HT is contraindicated or not desired. (IB)
5. There is limited evidence of benefit for most complementary and alternative approaches to the management of hot flashes. Without good evidence for effectiveness, and in the face of minimal data on safety, these approaches should be advised with caution. Women should be advised that, until January 2004, most natural health products were introduced into Canada as "food products" and did not fall under the regulatory requirements for pharmaceutical products. As such, most have not been rigorously tested for the treatment of moderate to severe hot flashes, and many lack evidence of efficacy and safety. (IB)
6. Any unexpected vaginal bleeding that occurs after 12 months of amenorrhea is considered postmenopausal bleeding and should be investigated. (IA)
7. HT should be offered to women with premature ovarian failure or early menopause (IA), and it can be recommended until the age of natural menopause. (IIIC)
8. Estrogen therapy can be offered to women who have undergone surgical menopause for the treatment of endometriosis. (IA)

Definitions:

Quality of Evidence Assessment*

I: Evidence obtained from at least one properly randomized controlled trial.

II-1: Evidence from well-designed controlled trials without randomization.

II-2: Evidence from well-designed cohort (prospective or retrospective) or case-control studies, preferably from more than one centre or research group.

II-3: Evidence from comparisons between times or places with or without the intervention. Dramatic results from uncontrolled experiments (such as the results of treatment with penicillin in the 1940s) could also be included in this category.

III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.

Classification of Recommendations**

A. There is good evidence to recommend the clinical preventive action

B. There is fair evidence to recommend the clinical preventive action

C. The existing evidence is conflicting and does not allow to make a recommendation for or against use of the clinical preventive action; however, other factors may influence decision-making

D. There is fair evidence to recommend against the clinical preventive action

E. There is good evidence to recommend against the clinical preventive action

L. There is insufficient evidence (in quantity or quality) to make a recommendation; however, other factors may influence decision-making

*The quality of evidence reported in these guidelines has been adapted from the Evaluation of Evidence criteria described in the Canadian Task Force on Preventive Health Care.***

**Recommendations included in these guidelines have been adapted from the Classification of Recommendations criteria described in the Canadian Task Force on Preventive Health Care.***

***Woolf SH, Battista RN, Angerson GM, Logan AG, Eel W. Canadian Task Force on Preventive Health Care. New grades for recommendations from the Canadian Task Force on Preventive Health Care. Can Med Assoc J 2003;169(3):207-8.

None provided

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

• Vasomotor symptoms. In: Menopause and osteoporosis update 2009. J Obstet Gynaecol Can 2009 Jan;31(1 Suppl 1):S9-10. [26 references]

Not applicable: The guideline was not adapted from another source.

2006 Feb (revised 2009 Jan)

Society of Obstetricians and Gynaecologists of Canada - Medical Specialty Society

Society of Obstetricians and Gynaecologists of Canada

Not stated

Principal Authors: Robert L. Reid, MD, FRCSC, Kingston ON; Jennifer Blake, MD, FRCSC, Toronto ON; Beth Abramson, MD, FRCPC, Toronto ON; Aliya Khan, MD, FRCPC, Hamilton ON; Vyta Senikas, MD, FRCSC, Ottawa ON; Michel Fortier, MD, FRCSC, Quebec QC

The following conflicts of interest have been disclosed by the authors.

Dr Reid: Speaker or consultant to Wyeth, Bayer, Organon, Proctor and Gamble, Novo Nordisk; advisory boards: Paladin, Wyeth; research support: Organon, Bayer.

Dr Blake: Speaker or consultant to Wyeth, Merck, Glaxo Smith Kline, Bayer; advisory boards: Bayer, Wyeth and Lilly, Novo Nordisk.

Dr Abramson: Speaker or consultant to Abbott, Astra Zeneca, Boehringer Ingelheim, Bristol Myer Squibb, Dupont, Eli Lilly, Lifespeak, Norvartis, Fournier, Merck Frosst, Pfizer, Servier, Schering, Sanofi-Aventis; advisory boards: Astra Zeneca, Boehringer-Ingelheim, Novartis, Pfizer, Sanofi-Aventis; research support: Astra Zeneca, Boehringer Ingelheim, Merck.

Dr Khan: Speaker or consultant to Amgen, Merck, Lilly, Novartis, Servier, Proctor and Gamble; research support: Merck, Lilly, Novartis, Alliance for Better Bone Health.

Dr Senikas: None declared.

Dr Fortier: Speaker or consultant to Proctor and Gamble, Merck; advisory boards: Amgen, Bayer, Novo Nordisk, Novartis, GlaxoSmith Kline, Lilly, Paladin; research support: Wyeth, Sanofi.

This is the current release of the guideline.

This guideline updates a previous version: Desindes S, Belisle S, Graves G. Menopause and age-related concerns. In: Canadian consensus conference on menopause, 2006 update. J Obstet Gynaecol Can 2006 Feb;28(2 Suppl 1):S21-32. [97 references]

Graves G, Blake J. Specific medical considerations. In: Canadian consensus conference on menopause, 2006 update. J Obstet Gynaecol Can 2006 Feb;28(2 Suppl 1):S75-80. [68 references]

None available

None available

This NGC summary was completed by ECRI Institute on April 30, 2009. The information was verified by the guideline developer on May 21, 2009.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.