European Menopause and Andropause Society (EMAS)

Position Statements

Summaries

Vitamin D and postmenopausal health

RESULTS AND CONCLUSIONS: Epidemiological and prospective studies have related vitamin D deficiency with not only osteoporosis but also cardiovascular disease, diabetes, cancer, infections and neurodegenerative disease....

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Managing menopausal women with a personal or family history of VTE
RESULTS AND CONCLUSIONS: Randomized controlled trials have shown an increased risk of VTE in oral hormone therapy (HT) users. There are no randomized trial data on the effect of transdermal estrogen on VTE. Recent observational studies and meta-analyses suggest that transdermal estrogen does not increase VTE risk. These clinical observations are supported by experimental data showing that transdermal estrogen has a minimal effect on hepatic metabolism of hemostatic proteins as the portal circulation is bypassed. A personal or family history of VTE, especially in individuals with a prothrombotic mutation, is a strong contraindication to oral HT but transdermal estrogen can be considered after careful individual evaluation of the benefits and risks. Transdermal estrogen should be also the first choice in overweight/obese women requiring HT. Observational studies suggest that micronized progesterone and dydrogesterone might have a better risk profile than other progestins with regard to VTE risk. Although these findings should be confirmed by randomized clinical trials, they strongly suggest that both the route of estrogen administration and the type of progestin may be important determinants of the overall benefit-risk profile of HT. Read more...


Managing the menopause in the context of coronary heart disease 2011
RESULTS AND CONCLUSIONS: Based on long term randomized placebo-controlled studies hormone therapy (HT) is not recommended for the primary or secondary prevention of CHD in postmenopausal women. In most countries the only indication for HT is the treatment of menopausal symptoms. Women with known CHD or with many coronary risk factors seeking HT because of troublesome climacteric symptoms should be evaluated for their individual baseline risk of developing breast cancer, venous thromboembolism and CHD recurrence. The same applies to non hormone therapy-based treatments where long term clinical studies are lacking. Risks should be weighed against expected benefit from symptom relief and improved quality of life. The lowest effective estrogen dose should be used during the shortest possible time. Transdermal administration is preferred if risk factors for VTE exist. Different progestogens might differ in their cardiovascular effects. Observational studies suggest that micronized progesterone or dydrogesterone may have a better risk profile than other progestogens with regard to thrombotic risk. Read more...

Bone densitometry screening for osteoporosis 2011
RESULTS AND CONCLUSIONS: Bone densitometry has an important role in screening postmenopausal women for osteoporosis. For higher sensitivity and specificity, there may be a stronger case for...Read more...
Managing the menopause in women with a past history of endometriosis 2010
RESULTS AND CONCLUSIONS: The data regarding hormone therapy regimens are limited. However it may be safer to give either continuous combined estrogen-progestogen therapies or ... Read more...
Managing women with premature ovarian failure 2010
RESULTS AND CONCLUSIONS: Diagnosis should be confirmed with an elevated FSH greater than 40 IU/L and an estradiol level below 50 pmol/L in the absence of ... Read more...

Managing the Menopause in women with epilepsy 2010
RESULTS AND CONCLUSIONS: Women with epilepsy may undergo an earlier natural menopause, between 3-5 years depending on seizure frequency, but the data are limited. Data regarding the effects of theperimenopause and menopause on epilepsy are conflicting...Read more...

Managing obese postmenopausal women 2010
RESULTS AND CONCLUSIONS: Obese women seeking hormone therapy should be evaluated for their individual baseline risk of developing breast cancer, cardiovascular disease and venous thromboembolism... Read more...

EMAS 2008 update on clinical recommendations on postmenopausal hormone replacement therapy
Using postmenopausal hormone replacement therapy has become controversial since the first publications of the Women’s Health Initiative and these recommendations provide a useful guide....Read more...