Menopause: appendices A-G

286 Pages·2015·6.34 MB·English

by  Annabel Flint

NCC-WCH

Version 1.2
Menopause
Appendices A - G
Clinical Guideline
Methods, evidence and recommendations
1 June 2015
Draft for Consultation

Commissioned by the National Institute for
Health and Clinical Excellence

MMeennooppaauussee

Contents

Disclaimer
Healthcare professionals are expected to take NICE clinical guidelines fully into account
when exercising their clinical judgement. However, the guidance does not override the
responsibility of healthcare professionals to make decisions appropriate to the circumstances
of each patient, in consultation with the patient and/or their guardian or carer.
Copyright
National Collaborating Centre for Women and Children's Health
Funding
The National Collaborating Centre for Women and Children’s Health was commissioned by
the National Institute for Health and Care Excellence to undertake the work on this guideline.

National Collaborating Centre for Women and Children's Health
Menopause

Contents
Contents
Appendices .......................................................................................................................... 7
Appendix A: Scope ...................................................................................................... 7
Appendix B: Stakeholders .......................................................................................... 22
Appendix C: Declarations of interest .......................................................................... 29
Appendix D: Review protocols ................................................................................... 35
D.1 Diagnosis of perimenopause and menopause .............................................. 35
D.2 Classification systems for the diagnosis of menopause ................................ 36
D.3 Information and advice ................................................................................. 37
D.4 Managing short-term symptoms ................................................................... 38
D.4.1 Management short-term symptoms: network meta-analyses .......... 40
D.4.2 Urogenital atrophy ........................................................................... 42
D.5 Review and referral ...................................................................................... 44
D.6 Starting and stopping HRT ........................................................................... 45
D.7 Long-terms benefits and risks of HRT ........................................................... 46
D.7.1 Venous thromboembolism .............................................................. 46
D.7.2 Cardiovascular disease (CVD) ........................................................ 47
D.7.3 Development of Type 2 diabetes ..................................................... 48
D.7.4 Management of Type 2 diabetes - control of blood sugar ................ 48
D.7.5 Breast cancer .................................................................................. 50
D.7.6 Osteoporosis ................................................................................... 51
D.7.7 Dementia ........................................................................................ 52
D.7.8 Loss of muscle mass (sarcopenia) .................................................. 52
D.8 Premature ovarian insufficiency (POI) .......................................................... 54
D.8.1 Diagnosis of premature ovarian insufficiency .................................. 54
D.8.2 Management of premature ovarian insufficiency ............................. 55
Appendix E: Search strategies ................................................................................... 56
E.1 Diagnosis of perimenopause and postmenopause / classification systems
for the diagnosis of menopause ................................................................... 56
E.2 Information and advice ................................................................................. 62
E.3 Managing short-term symptoms – clinical evidence ...................................... 65
E.4 Managing short-term symptoms – health economic evidence ....................... 76
E.4.1 Urogenital atrophy ........................................................................... 86
E.5 Review and referral ...................................................................................... 91
E.6 Starting and stopping HRT ......................................................................... 100
E.7 Long-term benefits and risks of HRT .......................................................... 103
E.7.1 Venous thromboembolism ............................................................ 109
E.7.2 Cardiovascular disease ................................................................. 113
E.7.3 Development of type 2 diabetes .................................................... 118

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E.7.4 Management of type 2 diabetes – control of blood sugar .............. 123
E.7.5 Breast cancer ................................................................................ 128
E.7.6 Osteoporosis ................................................................................. 132
E.7.7 Dementia ...................................................................................... 138
E.7.8 Loss of muscle mass (sarcopenia) ................................................ 143
E.8 Premature ovarian insufficiency .................................................................. 147
E.8.1 Management of premature ovarian insufficiency ........................... 147
E.8.2 Diagnosis of premature ovarian insufficiency ................................ 153
Appendix F: Prisma flow charts ............................................................................... 160
F.1 Diagnosis of perimenopause and postmenopause ..................................... 160
F.1.1 Classification systems for the diagnosis of menopause ................ 161
F.1.2 Information and advice .................................................................. 161
F.1.3 Managing short-term symptoms .................................................... 162
F.1.4 Urogenital atrophy ......................................................................... 162
F.2 Review and referral .................................................................................... 163
F.3 Starting and stopping HRT ......................................................................... 164
F.4 Long-term benefits and risks of HRT .......................................................... 164
F.4.1 Venous thromboembolism ............................................................ 164
F.4.2 Cardiovascular disease ................................................................. 165
F.4.3 Development of type 2 diabetes .................................................... 165
F.4.4 Management of type 2 diabetes – control of blood sugar .............. 166
F.4.5 Breast Cancer ............................................................................... 166
F.4.6 Osteoporosis ................................................................................. 167
F.4.7 Dementia ...................................................................................... 167
F.4.8 Loss of muscle mass (sarcopenia) ................................................ 168
F.5 Premature ovarian insufficiency .................................................................. 168
F.5.1 Diagnosis of premature ovarian insufficiency ................................ 168
F.5.2 Management of premature ovarian insufficiency ........................... 169
Appendix G: Excluded studies.................................................................................. 169
G.1 Diagnosis of perimenopause and menopause ............................................ 169
G.2 Classification systems for the diagnosis of menopause .............................. 175
G.3 Information and advice ............................................................................... 179
G.4 Managing short-term symptoms ................................................................. 184
G.4.1 Urogenital atrophy ......................................................................... 226
G.5 Review and referral .................................................................................... 232
G.6 Starting and stopping HRT ......................................................................... 232
G.7 Long-term benefits and risks of HRT .......................................................... 233
G.7.1 Venous thromboembolism ............................................................ 233
G.7.2 Cardiovascular disease ................................................................. 235
G.7.3 Development of type 2 diabetes .................................................... 242

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G.7.4 Management of type 2 diabetes – control of blood sugar .............. 243
G.7.5 Breast cancer ................................................................................ 244
G.7.6 Osteoporosis ................................................................................. 253
G.7.7 Dementia ...................................................................................... 258
G.7.8 Loss of muscle mass (sarcopenia) ................................................ 279
G.8 Premature ovarian insufficiency .................................................................. 281
G.8.1 Diagnosis of premature ovarian insufficiency ................................ 281
G.8.2 Management of premature ovarian insufficiency ........................... 283
Appendix H: Evidence tables ................................................................................... 285
Appendix I: GRADE profiles ................................................................................... 285
Appendix J: Forest plots .......................................................................................... 285
Appendix K: Network meta-analysis of interventions in the pharmacological and
non-pharmacological treatment of short term symptoms for women in
menopause .......................................................................................... 285

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Scope
Appendices
Appendix A: Scope

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Scope

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Menopause

Scope

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