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• W3201119611 abstract "<h2>ABSTRACT</h2><h3>Objective</h3> Provide strategies for improving the care of perimenopausal and postmenopausal women based on the most recent published evidence. <h3>Target Population</h3> Perimenopausal and postmenopausal women. <h3>Benefits, Harms, and Costs</h3> Target population will benefit from the most recent published scientific evidence provided via the information from their health care provider. No harms or costs are involved with this information since women will have the opportunity to choose among the different therapeutic options for the management of the symptoms and morbidities associated with menopause, including the option to choose no treatment. <h3>Evidence</h3> Databases consulted were PubMed, MEDLINE, and the Cochrane Library for the years 2002–2020, and MeSH search terms were specific for each topic developed through the 7 chapters. <h3>Validation Methods</h3> The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). <h3>Intended Audience</h3> physicians, including gynaecologists, obstetricians, family physicians, internists, emergency medicine specialists; nurses, including registered nurses and nurse practitioners; pharmacists; medical trainees, including medical students, residents, fellows; and other providers of health care for the target population. <h3>SUMMARY STATEMENTS</h3> <ul><li>1Low sexual desire in combination with distress is most common in women in mid-life (high).</li><li>2Vaginal atrophy is a common cause of sexual pain in menopausal women (high).</li><li>3Sexual dysfunction in menopausal women can be categorized as disorders involving desire, arousal, pain, and orgasm. These categories often overlap (high).</li><li>4A brief sexual history is part of the evaluation of menopausal women (moderate).</li><li>5The treatment of sexual dysfunctions involves a multifaceted approach that addresses medical, psychological, and relationship issues (high).</li><li>6Local estrogen therapy treats genitourinary syndrome of menopause (high).</li><li>7Pelvic physiotherapy is an excellent adjuvant treatment for hypercontracted pelvic floor muscles (often referred to as vaginismus) and genito-pelvic pain (low).</li><li>8Flibanserin has been shown to improve desire in women (moderate).</li><li>9Transdermal testosterone has been shown to increase desire, arousal, and satisfying sexual events, and to decrease personal distress (high).</li><li>10Psychological therapies, including cognitive behavioural therapy, mindfulness-based therapy, couples' therapy, and sexual therapies, are useful for treating sexual dysfunctions (moderate).</li><li>11Sexual dysfunction is common in patients with depression, those on selective serotonin reuptake inhibitors (SSRIs), women with primary ovarian insufficiency, and those with a history of breast cancer (high).</li></ul> <h3>RECOMMENDATIONS</h3> <ul><li>1The patient's problem should be categorized as related to desire, arousal, pain, or orgasm, in order to facilitate treatment and to triage care (strong, moderate).</li><li>2Health care providers should include a sexual screening history and physical examination in the initial evaluation of menopausal women (strong, low).</li><li>3Vaginal estrogens, lubricants and moisturizers, vaginal dehydroepiandrosterone, and ospemifene may be used as treatments for vaginal atrophy related to menopause (strong, high).</li><li>4For postmenopausal women with hypoactive sexual desire disorder, the best current options include managing pain, addressing any biopsychological factors, counselling, and prescribing transdermal testosterone (off-label) or flibanserin (strong, moderate).</li><li>5Patients with breast cancer and symptomatic genitourinary syndrome of menopause can be offered local vaginal estrogen if local lubricants and moisturizers are ineffective, after consulting with the patient's oncologist (conditional, moderate).</li></ul>" @default.
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• W3201119611 date "2021-11-01" @default.
• W3201119611 modified "2023-09-30" @default.
• W3201119611 title "Guideline No. 422d: Menopause and Sexuality" @default.
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• W3201119611 doi "https://doi.org/10.1016/j.jogc.2021.09.005" @default.
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