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<sup>1</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</b></u></a><br><br>
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>2</sup> <b>NAMS 2014.</b> Mod-to-severe = bothersome enough to interfere w/ daily activities, impair QOL, or interrupt sleep. All women encouraged to try lifestyle mod x≥3mo before beginning pharmacologic tx.
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<sup>3</sup> <b>NAMS 2014.</b> HT contraindications include: unexplained vag bleeding; liver dysfxn/dz; active/hx DVT/PE; clotting disorder/thrombophilia; untreated HTN; hx breast/endometrial CA/other estrogen-dependent tumor; hypersensitivity to HT, hx CHD/stroke/TIA. Women on thyroid meds may need dose adjustments.
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<sup>4</sup> <b>NAMS 2014.</b> If ≥1 1st-degree relative w/ breast CA, or otherwise @ increased risk (cancer.gov/bcrisktool) may want to consider nonhormonal tx.
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<sup>5</sup> <b>NAMS 2014.</b> Other SSRIs/SNRIs (off-label): venlafaxine 75-150 mg/day; escitalopram 10-20 mg/day; citalopram 10-30 mg/day; desvenlafaxine 50 mg/day; paroxetine HCl 10-20 mg/day; paroxetine CR 12.5-25 mg/day. Check product label for comprehensive contraindications/cautions.
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<sup>6</sup> <b>NAMS 2014.</b> Gabapentin 900-2400 mg/day (divided TID); pregabalin 150-300 mg/day (divided BID); clonidine 100 mcg/day. Check product label for comprehensive contraindications/cautions.
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>2</sup> <b>NAMS 2014.</b> Mod-to-severe = bothersome enough to interfere w/ daily activities, impair QOL, or interrupt sleep. All women encouraged to try lifestyle mod x≥3mo before beginning pharmacologic tx.
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<sup>3</sup> <b>NAMS 2014.</b> HT contraindications include: unexplained vag bleeding; liver dysfxn/dz; active/hx DVT/PE; clotting disorder/thrombophilia; untreated HTN; hx breast/endometrial CA/other estrogen-dependent tumor; hypersensitivity to HT, hx CHD/stroke/TIA. Women on thyroid meds may need dose adjustments.
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<sup>4</sup> <b>NAMS 2014.</b> If ≥1 1st-degree relative w/ breast CA, or otherwise @ increased risk (cancer.gov/bcrisktool) may want to consider nonhormonal tx.
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<sup>5</sup> <b>NAMS 2014.</b> Other SSRIs/SNRIs (off-label): venlafaxine 75-150 mg/day; escitalopram 10-20 mg/day; citalopram 10-30 mg/day; desvenlafaxine 50 mg/day; paroxetine HCl 10-20 mg/day; paroxetine CR 12.5-25 mg/day. Check product label for comprehensive contraindications/cautions.
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<sup>6</sup> <b>NAMS 2014.</b> Gabapentin 900-2400 mg/day (divided TID); pregabalin 150-300 mg/day (divided BID); clonidine 100 mcg/day. Check product label for comprehensive contraindications/cautions.
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Nonhormonal tx for menopausal<sup>1</sup> pts ≥45 yo<sup>1</sup> w/ mod-to-severe<sup>2</sup> vasomotor sx inadequately responsive to behavior mod<sup>2</sup> who have HT contraindications<sup>3,4</sup> or no interest in HT