Good Clinical Practice Recommendations for Menopause Care in Pakistan Issuing Organization: Pakistan Menopause Society (PMS)

Shamsunnisa Sadia

doi:10.71104/jsogp.v16i2.1086

Shamsunnisa Sadia Professor Islamic International Medical College, Riphah International University, Islamabad

DOI: https://doi.org/10.71104/jsogp.v16i2.1086

Keywords: Menopause, Menopausal Hormone Therapy, Lifestyle Modification, Vasomotor Symptoms, Good Clinical Practice

Abstract

Diagnosis: Clinical history is central. In healthy women aged ≥45 years with typical symptoms, menopause is usually diagnosed clinically without laboratory testing. Serum FSH is reserved for suspected premature ovarian insufficiency, early menopause or diagnostic uncertainty. Assessment should address menstrual pattern, symptom burden, quality of life, comorbidities and red flags.

Lifestyle & Psychosocial: Promote balanced nutrition, adequate calcium and vitamin D, regular aerobic and resistance exercise, restorative sleep, weight management, smoking cessation and caffeine moderation. Cognitive Behavioural Therapy, mindfulness, stress management and family support should be integrated where appropriate.

Menopausal Hormone Therapy (MHT) is the most effective treatment for vasomotor symptoms and supports genitourinary and bone health. Estrogen alone is appropriate after hysterectomy; women with an intact uterus require endometrial protection with progesterone or progestogens. Treatment should be individualized using the lowest effective dose and suitable route.

Non-Hormonal Treatment: Selective Serotonin Reuptake Inhibitor (SSRIs), Serotonin-Norepinephrine Reuptake Inhibitor (SNRIs), gabapentin, oxybutynin and neurokinin-receptor antagonists may be used when MHT is contraindicated or declined. Vaginal moisturizers and lubricants are first line for genitourinary symptoms. Complementary supplements require caution because evidence is limited.

Abnormal Bleeding: Postmenopausal, post-coital, persistent intermenstrual or unscheduled bleeding requires prompt investigation, guided by bleeding pattern, endometrial thickness and individual risk.

Special Populations: Women with premature ovarian insufficiency, early menopause, complex comorbidities or hormone-sensitive cancers require individualized specialist care.

Follow-up: Review at 3 and 6 months, then annually. Shared decision-making and multidisciplinary care are essential.