Numbers correspond to section of text addressing selected clinical issue. From: Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice.

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Numbers correspond to section of text addressing selected clinical issue. From: Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline J Clin Endocrinol Metab. 2015;100(11):3975-4011. doi:10.1210/jc.2015-2236 J Clin Endocrinol Metab | Copyright © 2015 by the Endocrine SocietyThis article is published under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License (CC-BY-NC-ND; http://creativecommons.org/licenses/by-nc-nd/4.0/).

TIA, transient ischemic attack. From: Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline J Clin Endocrinol Metab. 2015;100(11):3975-4011. doi:10.1210/jc.2015-2236 J Clin Endocrinol Metab | Copyright © 2015 by the Endocrine SocietyThis article is published under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License (CC-BY-NC-ND; http://creativecommons.org/licenses/by-nc-nd/4.0/).

One set of analyses examined the risks and benefits of these agents in women ages 50–59 years. This figure plots these data, which are expressed here as excess risks and benefits per 1000 women using MHT for 5 years. Because women deciding to use MHT are more likely to continue this for a period of years rather than 1 year, this figure is constructed according to that assumption. WHI studies were not powered for age-related subset analyses, and none of the data presented in the figure are statistically significant. Nonetheless, this figure represents the best estimates that are available at the present time and are likely more reliable than similar estimates based on observational studies as reported previously in The Endocrine Society Scientific Statement (38). The HR (95% CI) values for the bars in the figure are listed here with reference to the alphabetical designations shown next to the bars: a, HR, 0.60 (0.35–1.04); b, HR, 1.34 (0.82–2.19); c, HR, 0.82 (0.50–1.34); d, HR, 1.21 (0.81–1.80); e, HR, 0.99 (0.53–1.85); f, HR, 1.51 (0.81–2.82); g, HR, 1.53 (0.63–3.75); h, HR, 2.05 (0.89–4.71); i, HR, 1.66 (0.76–3.67); j, HR, 3.01 (1.36–6.66); k, HR, 0.71 (0.30–1.67); l, HR, 0.79 (0.29–2.18); m, HR, 1.00 (ns-ns); n, HR, 1.12 (0.45–2.75); o, HR, 0.62 (0.30–1.29); p, HR, 0.90 (0.72–1.11); q, HR, 0.82 (0.68–1.00); r, HR, 5.01 (0.59–42.9); s, HR, 0.17 (0.02–1.45); t, HR, 0.70 (0.46–1.09); u, HR, 0.67 (0.43–1.04); v, HR, 0.83 (0.67–1.04); and w, HR, 0.85 (0.66–1.09). [RJ Santen, et al: Competency in menopause management: whither goest the internist? J Womens Health (Larchmt). 2014;23(4):281–285, courtesy of Mary Ann Liebert, Inc]. From: Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline J Clin Endocrinol Metab. 2015;100(11):3975-4011. doi:10.1210/jc.2015-2236 J Clin Endocrinol Metab | Copyright © 2015 by the Endocrine SocietyThis article is published under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License (CC-BY-NC-ND; http://creativecommons.org/licenses/by-nc-nd/4.0/).

Upper panel, Effect on frequency of VMS; lower panel, effect on composite score (severity times frequency; best representation of effect); open bars, placebo; colored bars, therapies; length of bars, ranges in studies; horizontal bar, means. All of these agents are generally well tolerated (226). Hypersensitivity or prior adverse drug reactions to each of these agents represent contraindications. For the SSRI/SNRIs, prior neuroleptic syndrome, serotonin syndrome, and concurrent use of monoamine oxidase inhibitors are also contraindications. SSRI/SNRIs should be used with caution in patients with bipolar disease, uncontrolled seizures, hepatic or renal insufficiency, uncontrolled hyponatremia, concurrent use of other SSRI/SNRIs, or poorly controlled hypertension. These agents uncommonly induce suicidal thoughts within the first few months of treatment. Preliminary evidence suggests a possible increase in risk of bone fracture. Gabapentin and pregabalin may increase suicidal thoughts and behaviors, cause drowsiness or dizziness, and impair balance and coordination. Pregabalin may impair memory and concentration. Clonidine is contraindicated in patients with low blood pressure and may cause lightheadedness, hypotension, headache, and constipation; sudden cessation of treatment can be associated with significant increments in blood pressure (63). From: Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline J Clin Endocrinol Metab. 2015;100(11):3975-4011. doi:10.1210/jc.2015-2236 J Clin Endocrinol Metab | Copyright © 2015 by the Endocrine SocietyThis article is published under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License (CC-BY-NC-ND; http://creativecommons.org/licenses/by-nc-nd/4.0/).