Abstract：
OBJECTIVE: To identify and appraise current national and international clinical menopause guidance documents, and to extract and compare the recommendations of the most robust examples.
METHODS: Systematic review.
METHODS: Ovid MEDLINE, EMBASE, PsycINFO and Web of Science ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Practice guidance documents for menopause published from 2015 until 20 July 2023. Quality was assessed by the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument.
RESULTS: Twenty-six guidance papers were identified. Of these, five clinical practice guidelines (CPGs) and one non-hormonal therapy position statement met AGREE II criteria of being at least of moderate quality. The five CPGs listed symptoms associated with the perimenopause and menopause to be vasomotor symptoms (VMS), disturbed sleep, musculoskeletal pain, decreased sexual function or desire, and mood disturbance (low mood, mood changes or depressive symptoms). Acknowledged potential long-term menopause consequences were urogenital atrophy, and increased risks of cardiovascular disease and osteoporosis. VMS and menopause-associated mood disturbance were the only consistent indications for systemic menopausal hormone therapy (MHT). Some CPGs supported MHT to prevent or treat osteoporosis, but specific guidance was lacking. None recommended MHT for cognitive symptoms or prevention of other chronic disease. Perimenopause-specific recommendations were scant. A neurokinin 3B antagonist, selective serotonin/norepinephrine (noradrenaline) reuptake inhibitors and gabapentin were recommended non-hormonal medications for VMS, and cognitive behavioural therapy and hypnosis were consistently considered as being of potential benefit.
CONCLUSIONS: The highest quality CPGs consistently recommended MHT for VMS and menopause-associated mood disturbance, whereas clinical depression or cognitive symptoms, and cardiometabolic disease and dementia prevention were not treatment indications. Further research is needed to inform clinical recommendations for symptomatic perimenopausal women.
METHODS: Systematic review.
METHODS: Ovid MEDLINE, EMBASE, PsycINFO and Web of Science ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Practice guidance documents for menopause published from 2015 until 20 July 2023. Quality was assessed by the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument.
RESULTS: Twenty-six guidance papers were identified. Of these, five clinical practice guidelines (CPGs) and one non-hormonal therapy position statement met AGREE II criteria of being at least of moderate quality. The five CPGs listed symptoms associated with the perimenopause and menopause to be vasomotor symptoms (VMS), disturbed sleep, musculoskeletal pain, decreased sexual function or desire, and mood disturbance (low mood, mood changes or depressive symptoms). Acknowledged potential long-term menopause consequences were urogenital atrophy, and increased risks of cardiovascular disease and osteoporosis. VMS and menopause-associated mood disturbance were the only consistent indications for systemic menopausal hormone therapy (MHT). Some CPGs supported MHT to prevent or treat osteoporosis, but specific guidance was lacking. None recommended MHT for cognitive symptoms or prevention of other chronic disease. Perimenopause-specific recommendations were scant. A neurokinin 3B antagonist, selective serotonin/norepinephrine (noradrenaline) reuptake inhibitors and gabapentin were recommended non-hormonal medications for VMS, and cognitive behavioural therapy and hypnosis were consistently considered as being of potential benefit.
CONCLUSIONS: The highest quality CPGs consistently recommended MHT for VMS and menopause-associated mood disturbance, whereas clinical depression or cognitive symptoms, and cardiometabolic disease and dementia prevention were not treatment indications. Further research is needed to inform clinical recommendations for symptomatic perimenopausal women.
摘要：
目的：确定和评估当前的国家和国际临床更年期指导文件，并提取和比较最可靠示例的建议。
方法：系统评价。
方法：OvidMEDLINE，EMBASE,PsycINFO和WebofScience选择研究标准：从2015年到2023年7月20日发布的更年期实践指导文件。质量通过评估研究和评估指南II（AGREEII）工具进行评估。
结果：确定了26篇指导文件。其中,5个临床实践指南(CPG)和1个非激素治疗立场声明符合AGREEII标准,即质量至少中等.五个CPG列出了与围绝经期和更年期相关的症状是血管舒缩症状（VMS），睡眠不安,肌肉骨骼疼痛，性功能或欲望下降，和情绪障碍(情绪低落，情绪变化或抑郁症状)。承认潜在的长期更年期后果是泌尿生殖器萎缩，心血管疾病和骨质疏松症的风险增加。VMS和更年期相关的情绪障碍是全身更年期激素治疗（MHT）的唯一一致适应症。一些CPG支持MHT预防或治疗骨质疏松症，但缺乏具体的指导。没有人建议将MHT用于认知症状或预防其他慢性疾病。针对围绝经期的建议很少。神经激肽3B拮抗剂，选择性5-羟色胺/去甲肾上腺素（去甲肾上腺素）再摄取抑制剂和加巴喷丁被推荐用于VMS的非激素药物，认知行为治疗和催眠一直被认为是潜在的益处.
结论：最高质量的CPG始终推荐MHT用于VMS和更年期相关的情绪障碍，而临床抑郁症或认知症状，心脏代谢疾病和痴呆预防不是治疗指征.需要进一步的研究来为有症状的围绝经期妇女提供临床建议。
方法：系统评价。
方法：OvidMEDLINE，EMBASE,PsycINFO和WebofScience选择研究标准：从2015年到2023年7月20日发布的更年期实践指导文件。质量通过评估研究和评估指南II（AGREEII）工具进行评估。
结果：确定了26篇指导文件。其中,5个临床实践指南(CPG)和1个非激素治疗立场声明符合AGREEII标准,即质量至少中等.五个CPG列出了与围绝经期和更年期相关的症状是血管舒缩症状（VMS），睡眠不安,肌肉骨骼疼痛，性功能或欲望下降，和情绪障碍(情绪低落，情绪变化或抑郁症状)。承认潜在的长期更年期后果是泌尿生殖器萎缩，心血管疾病和骨质疏松症的风险增加。VMS和更年期相关的情绪障碍是全身更年期激素治疗（MHT）的唯一一致适应症。一些CPG支持MHT预防或治疗骨质疏松症，但缺乏具体的指导。没有人建议将MHT用于认知症状或预防其他慢性疾病。针对围绝经期的建议很少。神经激肽3B拮抗剂，选择性5-羟色胺/去甲肾上腺素（去甲肾上腺素）再摄取抑制剂和加巴喷丁被推荐用于VMS的非激素药物，认知行为治疗和催眠一直被认为是潜在的益处.
结论：最高质量的CPG始终推荐MHT用于VMS和更年期相关的情绪障碍，而临床抑郁症或认知症状，心脏代谢疾病和痴呆预防不是治疗指征.需要进一步的研究来为有症状的围绝经期妇女提供临床建议。
