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has led the development of a toolkit aimed at guiding health professionals around the world in assessing and treating women with menopausal health issues.

Endorsed by the International, Australasian and British Menopause Societies, and , the 2023 Practitioner鈥檚 Toolkit for Managing the Menopause is designed to be used anywhere in the world.

The latest Toolkit, published in , has been updated and enhanced from the original 2014 Toolkit for practitioners with new advice and therapies based on a systematic review of the latest menopause research and best practice.

Bone health guidance

As well as outlining the latest general treatment guidelines, it offers bone health guidance as part of a menopause health assessment. For example, clear guidelines about when menopause hormone therapies (MHT) might be needed to prevent bone loss and osteoporosis in asymptomatic women were lacking in 2014.

The update also incorporates new medications including fezolinetant (hot flushes), ospemifene (painful sex) and vaginal DHEA (vaginal dryness), with some soon to be available in Australia. First author and Monash University Women鈥檚 Health Research Program head Professor Susan Davis, who also led development of the 2014 Toolkit, said the update included some new therapies but did not support MHT for cognitive symptoms or clinical depression.

Cognitive function

鈥淔or cognitive symptoms, clinical trials have not shown a benefit of MHT for cognitive function,鈥� Davis said. 鈥淭he most robust studies have shown it to be no better than placebo.

鈥淩egarding depression, menopause may cause symptoms such as low mood, anxiety, irritability and mood swings, but clinical depression needs to be assessed and managed in its own right. Menopause might exacerbate underlying depression but should not be assumed to be the cause of clinical depression.鈥�

Hormone therapy

Davis said the advice was now much clearer around preventing bone loss and fracture.

鈥淭o our knowledge this is the only document that provides guidance for using hormone therapy to prevent fracture,鈥� she said. 鈥淥ther recommendations have been vague such as 鈥榗an be used to prevent bone loss/fracture鈥� or 鈥榰se to treat osteopenia鈥�.鈥�

Senior author Dr Rakib Islam, from the Monash University School of Public Health and Preventive Medicine Women鈥檚 Health Research Program, said the updates would make a difference for many.

鈥淭he 2023 Practitioner鈥檚 Toolkit is the most up-to-date, evidence-based practical guidance for healthcare providers to menopause care globally,鈥� he said.

Davis said it was important for women to see their GP if they experienced troubling physical or mental health symptoms, and the update aimed to ensure GPs were well equipped.

Patient-informed care

鈥淲e have updated this as part of an NHMRC Grant to upskill GPs and to embed the care algorithms into GP practice software in the MenoPROMPT study program, which aims to improve care for women who need it,鈥� she said.

鈥淭his is a very important feature of this update.鈥�

The paper鈥檚 authors suggested the recommendations needed to be applied in the context of local availability and the cost of investigations and drug therapies. 鈥淢ost importantly, the Toolkit provides the full spectrum of available options and therefore can be used to support shared decision making, and patient-informed care,鈥� they wrote.

Image credit: iStockphoto.com/Mohamad Faizal Bin Ramli