Sharing the multidisciplinary clinical approach to peri- and postmenopausal women: A Delphi consensus among Italian gynecologists, endocrinologists, and cardiologists for an integrated and optimal approach to clinical practice.
Delphi consensus
comorbidities
intersociety consensus
menopause
perimenopause
postmenopause
Journal
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics
ISSN: 1879-3479
Titre abrégé: Int J Gynaecol Obstet
Pays: United States
ID NLM: 0210174
Informations de publication
Date de publication:
25 Feb 2024
25 Feb 2024
Historique:
revised:
07
02
2024
received:
21
12
2023
accepted:
12
02
2024
medline:
26
2
2024
pubmed:
26
2
2024
entrez:
26
2
2024
Statut:
aheadofprint
Résumé
The critical phase of perimenopausal period is marked by a reduction in estrogen levels, leading to various clinical issues (vasomotor and neurodegenerative symptoms, increased osteoporosis risk and cardiovascular risk). These complex clinical scenarios pose challenges to clinicians in providing the right support for diagnosis and treatment. A group of Italian cardiologists, endocrinologists, and gynecologists conducted a survey among expert colleagues to assess consensus on controversial issues and best practices for screening and treating peri- and postmenopausal women. The Delphi methodology was used to analyze responses from a qualitative expert panel comprising 25 cardiologists, 25 endocrinologists, and 25 gynecologists, selected nationwide. Two consecutive questionnaires were proposed between February and May 2023. Agreement among experts was assessed following the Delphi method as developed by the RAND Corporation. The results of this Delphi Consensus have been shared by the leading scientific societies: Italian Society of Cardiology, Italian Society of Endocrinology, Italian Society of Gynecology and Obstetrics, and Italian Hospital Obstetricians Gynecologists Association. The experts highlighted comorbidities and hormone deprivation as crucial clinical problems to be evaluated in perimenopausal women, requiring investigation from cardiovascular and endocrinologic perspectives to assess cardiovascular risk, involving the use of BMI, standard blood samples, endocrine-metabolic tests, and lifestyle assessment, particularly in women with higher cardiovascular and metabolic risks candidates for hormone replacement therapy (HRT). The experts also agreed on the benefits of HRT in improving lipid metabolism and reducing insulin resistance, thereby mitigating the metabolic risks associated with menopause. However, this therapy should be tailored considering individual women's comorbidities and thrombotic risk.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Organon Italia
Informations de copyright
© 2024 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.
Références
Voedisch AJ, Dunsmoor-Su R, Kasirsky J. Menopause: a global perspective and clinical guide for practice. Clin Obstet Gynecol. 2021;64(3):528-554.
Sherman S. Defining the menopausal transition. Am J Med. 2005;118(Suppl 12B):3-7.
Santoro N, Roeca C, Peters BA, Neal-Perry G. The menopause transition: signs, symptoms, and management options. J Clin Endocrinol Metab. 2021;106(1):1-15.
Maas AH, Appelman YE. Gender differences in coronary heart disease. Neth Hear J. 2010;18(12):598-602. doi:10.1007/s12471-010-0841-y
Tandon VR, Mahajan A, Sharma S, Sharma A. Prevalence of cardiovascular risk factors in postmenopausal women: a rural study. J Midlife Health. 2010;1(1):26-29.
Guay M-P, Dragomir A, Pilon D, Moride Y, Perreault S. Changes in pattern of use, clinical characteristics and persistence rate of hormone replacement therapy among postmenopausal women after the WHI publication. Pharmacoepidemiol Drug Saf. 2007;16(1):17-27.
Buhling KJ, von Studnitz FSG, Jantke A, Eulenburg C, Mueck AO. Attitude of German gynaecologists towards prescribing HRT before and after the WHI study. Climacteric. 2012;15(4):326-331.
Collins P, Rosano G, Casey C, et al. Management of cardiovascular risk in the perimenopausal women: a consensus statement of European cardiologists and gynaecologists. Climacteric. 2007;10(6):508-526.
Cobin RH, Goodman NF, AACE Reproductive Endocrinology Scientific Committee. American association of clinical endocrinologists and american college of endocrinology position statement on menopause-2017 update. Endocr Pract. 2017;23(7):869-880.
Cagnacci A, Gambacciani M, Gallo M, Lello S, Executive Committee of the Italian Society of Menopause (SIM) and of the Italian Society of Gynaecology of the Third Age (SIGiTE). Recommendations on menopausal hormone replacement therapy. Practice guideline. Minerva Ginecol. 2019;71(6):395-403.
Maas AHEM, Rosano G, Cifkova R, et al. Cardiovascular health after menopause transition, pregnancy disorders, and other gynaecologic conditions: a consensus document from European cardiologists, gynaecologists, and endocrinologists. Eur Heart J. 2021;42(10):967-984.
Rozenberg S, Panay M, Gambacciani M, Cano A, Gray S, Schaudi K. Breaking down barriers for prescribing and using hormone therapy for the treatment of menopausal symptoms: an experts' perspective. Expert Rev Clin Pharmacol. 2023;16(6):507-517.
Fitch K, Bernstein SJ, Aguilar MD, Burnand B, LaCalle JR. The RAND/UCLA Appropriateness Method User's Manual. RAND Corporation; 2001. https://www.rand.org/pubs/monograph_reports/MR1269.html
Diamond IR, Grant RC, Feldman BM, et al. Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies. J Clin Epidemiol. 2014;67:401-409.
Linstone H, Turoff M, eds. The Delphi Method: Techniques and Applications. Addison-Wesley Publishing Company; 1995:1-616.
Jones J, Hunter D. Qualitative research: consensus methods for medical and health services research. BMJ. 1995;311:376-380.
Rowe G, Wright G. The Delphi technique as a forecasting tool: issues and analysis. Int J Forecast. 1999;15:353-375.
Graham B, Regehr G, Wright J. Delphi as a method to establish consensus for diagnostic criteria. J Clin Epidemiol. 2003;56:1150-1156.
Davis SR, Moreau M, Kroll R, et al. Testosterone for low libido in postmenopausal women not taking estrogen. N Engl J Med. 2008;359(19):2005-2017. doi:10.1056/NEJMoa0707302
Islam RM, Bell RJ, Green S, Page MJ, Davis SR. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. Lancet Diabetes Endocrinol. 2019;7(10):754-766. doi:10.1016/S2213-8587(19)30189-5
Lyman GH, Greenlee H, Bohlke K, et al. Integrative therapies during and after breast cancer treatment: ASCO endorsement of the SIO clinical practice guideline. J Clin Oncol. 2018;36(25):2647-2655. doi:10.1200/JCO.2018.79.2721
Ayers B, Mann E, Hunter MS. A randomised controlled trial of cognitive-behavioural therapy for women with problematic menopausal hot flushes: MENOS 2 trial protocol. BMJ Open. 2011 Feb 23;1(1):e000047. doi:10.1136/bmjopen-2010-000047
Chen TL, Chang SC, Huang CY, Wang HH. Effectiveness of mindfulness-based interventions on quality of life and menopausal symptoms in menopausal women: a meta-analysis. J Psychosom Res. 2021;147:110515. doi:10.1016/j.jpsychores.2021.110515
Johnson A, Roberts L, Elkins G. Complementary and alternative medicine for menopause. J Evid Based Integr Med. 2019;24:2515690X19829380. doi:10.1177/2515690X19829380
Diem SJ, LaCroix AZ, Reed SD, et al. Effects of pharmacologic and nonpharmacologic interventions on menopause-related quality of life: a pooled analysis of individual participant data from four MsFLASH trials. Menopause. 2020 Oct;27(10):1126-1136. doi:10.1097/GME.0000000000001597
Becorpi A, Campisciano G, Zanotta N, et al. Fractional CO2 laser for genitourinary syndrome of menopause in breast cancer survivors: clinical, immunological, and microbiological aspects. Lasers Med Sci. 2018;33(5):1047-1054. doi:10.1007/s10103-018-2471-3
Tseng YL, Su CF. Efficacy and safety of intraurethral Erbium:YAG laser treatment in women with stress urinary incontinence following failed intravaginal laser therapy: a retrospective study. Lasers Med Sci. 2023 Sep 9;38(1):207. doi:10.1007/s10103-023-03872-5
Joris A, Di Pietrantonio V, Praet J, et al. Randomized trial: treatment of genitourinary syndrome of menopause using radiofrequency. Climacteric. 2024;22:1-5. doi:10.1080/13697137.2024.2302425
Takahashi TA, Johnson KM. Menopause. Med Clin North Am. 2015;99(3):521-534. doi:10.1016/j.mcna.2015.01.006
The Women's Health Initiative. Accessed January 10, 2024. https://www.womenshealth.gov/30-achievements/25
The Million Women Study. Accessed January 10, 2024. https://www.ceu.ox.ac.uk/research/the-million-women-study
The European Prospective Investigation into Cancer and Nutrition (EPIC). Accessed January 10, 2024. https://epic.iarc.fr/
The Nurses' Health Study. Accessed January 10, 2024. https://nurseshealthstudy.org/
The International Menopause Society (IMS) Recommendations. Accessed January 10, 2024. https://www.imsociety.org/statements/ims-recommendations/
Vigneswaran K, Hamoda H. Hormone replacement therapy - current recommendations. Best Pract Res Clin Obstet Gynaecol. 2022;81:8-21.
Levin VA, Jiang X, Kagan R. Estrogen therapy for osteoporosis in the modern era. Osteoporos Int. 2018;29(5):1049-1055.
Gialeraki A, Valsami S, Pittaras T, Panayiotakopoulos G, Politou M. Oral contraceptives and HRT risk of thrombosis. Clin Appl Thromb Hemost. 2018;24(2):217-225.
Deli T, Orosz M, Jakab A. Hormone replacement therapy in cancer survivors - review of the literature. Pathol Oncol Res. 2020;26(1):63-78.
Hodis HN, Mack WJ. Menopausal hormone replacement therapy and reduction of all-cause mortality and cardiovascular disease: it is about time and timing. Cancer J. 2022;28(3):208-223.