PG25: Managing Menopause...With Fingers On The Pulse And Eyes On The Future

Date:October 13, 2013

Time:8:15 am - 5:00 pm

Location:Room 208 - Boston Convention and Exhibition Center


Lubna Pal, M.B.B.S., M.S. (Chair), Yale University School of Medicine

Nanette F. Santoro, M.D., University of Colorado at Denver

Genevieve Neal-Perry, M.D., Ph.D., Albert Einstein College of Medicine and Montefiore Medical Center


Developed in Cooperation with the Menopause Special Interest Group

ACGME Competency
Patient care 

Menopausal management has transformed over the past decade, with an obvious shift from a relatively liberal use of exogenous hormones in the pre-Women’s Health Initiative era, to a more cautious stance regarding the place of menopausal hormone therapy in the management of menopause-related symptoms. Concerns regarding long-term implications of menopausal hormone therapy appear to underlie this change in clinical practice. Although today’s clinicians are sensitized to the unique needs of an individual menopausal woman, and are better aware of the expanding spectrum of therapeutic options, the management paradigms still remain ambiguous for many and the dichotomy of findings from observational studies and randomized trials continue to confuse patients and providers alike. Easy access to “proverbial” and “anecdotal” information via the Internet has magnified the complexity of clinician-patient discussions and frequently influences patient choices and decisions related to menopause management. 

Early diagnosis and advances in the field of oncology are contributing to increasing numbers of relatively young cancer survivors who are experiencing premature ovarian insufficiency after chemo-radiation therapy. Clinical evidence suggests that the health burden attributable to premature cessation of ovarian function in this population may not be adequately appreciated or addressed. It is thus essential for clinicians who care for young female cancer survivors to understand the needs and concerns relating to iatrogenic menopause in this unique population. 

Today’s targeted approach to clinical practice may restrict a clinician’s ability to explore an individual patient’s non-verbalized concerns, an aspect that is of particular relevance for women transgressing the spectrum of peri and early menopause. In addition to being cognizant of climacteric symptoms and the available strategies for symptom control, providers should also be prepared to treat the needs of perimenopausal and early menopausal women, including preventive care, risk quantification and risk reduction, and contraceptive and procreative preferences. The future of menopausal management, driven by concepts of selective estrogen receptor modulators (SERMs), tissue selective estrogen complexes (TSECs) and stem cell therapy, promises a dynamic terrain that is likely to redefine how we care for the perimenopausal and menopausal woman. 

The decision to offer a particular management strategy is dictated by the patient’s clinical presentation and a thorough evaluation of the individualized risk versus benefit profile. Large gaps exist between patient expectations and provider competency to help guide patient decision making. Consistent with the literature, surveys conducted by the American Society for Reproductive Medicine (ASRM) in 2009 and 2011 members identified personal practice gaps in the treatment of menopause-related issues, and requested educational activities to specifically address their understanding of individualized treatment approaches. The goal of this live course is to offer a critical review of evidence-based recommendations that will give clinicians the skill set to provide  comprehensive, competent care to women making the transition into menopause.

At the completion of this seminar, the participant will be able to:

  1. Individualize risk assessment and recommend risk reduction strategies for peri and postmenopausal women, and develop optimal, individualized management strategies of contraceptive and procreative needs in the perimenopausal population.
  2. Compare and contrast the efficacy, safety and side effects of available therapies (hormonal and non-hormonal) for common menopausal disorders, and design treatment plans for women with diverse disease states and of different ages with menopausal symptoms and/or osteoporosis.
  3. Distinguish the unique needs and risks of women experiencing unnatural menopause (premature, surgical or following chemo-radiation), and develop individualized management strategies.
  4. Explain emerging concepts in menopausal medicine (e.g., SERMs, TSECs and stem cell).


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