The most recent American Association of Clinical Endocrinologists (AACE)/American College of Endocrinology (ACE) clinical practice guidelines for the treatment of menopause was published in 2011 (1). This AACE/ACE Position Statement was produced in accordance with the “American Association of Clinical Endocrinologists and American College of Endocrinology Protocol for Standardized Production of Clinical Practice Guidelines, Algorithms, and Checklists – 2014 Update.” Each recommendation was graded and based on evidence, which was evaluated and rated by a panel of experts. The position statement does not replace the previous guideline. Unless otherwise noted, recommendations have not changed. This statement will focus on new information from evidence published since the last guidelines, “AACE Medical Guidelines for Clinical Practice for Diagnosis and Treatment of Menopause.”
The publication of the Women's Health Initiative (WHI) in 2002 represented the first large, randomized controlled clinical trial of hormone replacement therapy (HRT). In contrast to previous epidemiologic studies, observational studies, or smaller trials, the WHI found a negative impact of HRT on cardiovascular risk in postmenopausal women, while finding a small increase in relative risk of breast cancer in women treated with estrogen/progesterone combination, but not with estrogen alone. The previous AACE/ACE menopause clinical practice guidelines reviewed these and other outcomes from the WHI. The WHI, however, was confined to older women with a mean age of 63 years, many years after menopause, and to those without vasomotor symptoms.
Since the publication of the AACE/ACE menopause guidelines, a number of post hoc analyses of WHI have been published. The Kronos Early Estrogen Prevention Study (KEEPS) trial evaluated the impact of HRT on younger postmenopausal women. A number of additional studies of breast cancer in hormone-treated women have also been completed. Additional studies comparing various hormone types and routes of administration have been published. The use of bioidentical hormone treatment was discussed in the last edition of the guidelines, but since then, the U.S. Food and Drug Administration (FDA) has issued further warnings regarding this form of therapy, re-enforcing AACE's previous recommendation. Finally, the use of nonhormonal remedies in the management of menopausal symptoms has been expanded.
The current review will provide an update on these issues.Access the Full Statement