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Footnote
<sup>1</sup> <b>NAMS 2020.</b> The 2020 Genitourinary Syndrome of Menopause Position Statement of the North American Menopause Society. <i>Menopause: The Journal of the North American Menopause Society.</i> 2020. Vol. 27, No. 9, pp. 976/992. <a href=https://www.menopause.org/docs/default-source/default-document-library/2020-gsm-ps.pdf><b><u>PDF</u></b></a><br><br>
<sup>2</sup> <b>NAMS 2014.</b> Guideline & mobile app for menopausal sx mgmnt & hormonal/nonhormonal therapy decision making from NAMS. <i>Menopause: The Journal of The North American Menopause Society.</i> 2014. Vol. 22, No. 3, pp. 000/000. <a href=http://www.menopause.org/docs/default-source/2014/menopro-app-algorithm-2014.pdf><b><u>PDF</u></b></a>
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These women may need additional clinical eval before applying this guideline: <45 yo, not clearly menopausal, s/p endometrial ablation, w/ progestin-releasing intrauterine device/system, s/p hysterectomy w/o removal of ovaries; additional eval may include hCG, FSH, TSH, prolactin, other tests. This guideline can be applied to women s/p BL oophorectomy, of any age.
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<sup>3</sup> <b>NAMS 2014.</b> Vaginal estrogen contraindications include: unexplained vag bleeding, known/suspected breast CA or other estrogen-dependent neoplasia. Ospemifene contraindications include those for vaginal estrogen plus past/current venous/arterial thromboembolic dz. Check product label for comprehensive contraindications/cautions.
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<sup>4</sup> <b>NAMS 2014.</b> Women @ high osteoporotic fx risk who are unable to tolerate standard preventive med also may be reasonable systemic HT candidates, even if they do not have mod-to-severe vasomotor sx. HT for osteoporosis prevention is controversial.
<sup>2</sup> <b>NAMS 2014.</b> Guideline & mobile app for menopausal sx mgmnt & hormonal/nonhormonal therapy decision making from NAMS. <i>Menopause: The Journal of The North American Menopause Society.</i> 2014. Vol. 22, No. 3, pp. 000/000. <a href=http://www.menopause.org/docs/default-source/2014/menopro-app-algorithm-2014.pdf><b><u>PDF</u></b></a>
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These women may need additional clinical eval before applying this guideline: <45 yo, not clearly menopausal, s/p endometrial ablation, w/ progestin-releasing intrauterine device/system, s/p hysterectomy w/o removal of ovaries; additional eval may include hCG, FSH, TSH, prolactin, other tests. This guideline can be applied to women s/p BL oophorectomy, of any age.
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<sup>3</sup> <b>NAMS 2014.</b> Vaginal estrogen contraindications include: unexplained vag bleeding, known/suspected breast CA or other estrogen-dependent neoplasia. Ospemifene contraindications include those for vaginal estrogen plus past/current venous/arterial thromboembolic dz. Check product label for comprehensive contraindications/cautions.
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<sup>4</sup> <b>NAMS 2014.</b> Women @ high osteoporotic fx risk who are unable to tolerate standard preventive med also may be reasonable systemic HT candidates, even if they do not have mod-to-severe vasomotor sx. HT for osteoporosis prevention is controversial.
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Choice of tx depends on sx severity, effectiveness and safety of tx for individual pt, and pt preference<sup>1</sup>