Asociación Española para el Estudio de la Menopausia (AEEM), Spain.
Asociación Española para el Estudio de la Menopausia (AEEM), Spain.
Maturitas. 2022 Dec;166:65-85. doi: 10.1016/j.maturitas.2022.08.008. Epub 2022 Aug 30.
This project aims to develop eligibility criteria for menopausal hormone therapy (MHT). The tool should be similar to those already established for contraception A consortium of scientific societies coordinated by the Spanish Menopause Society met to formulate recommendations for the use of MHT by women with medical conditions based on the best available evidence. The project was developed in two phases. As a first step, we conducted 14 systematic reviews and 32 metanalyses on the safety of MHT (in nine areas: age, time of menopause onset, treatment duration, women with thrombotic risk, women with a personal history of cardiovascular disease, women with metabolic syndrome, women with gastrointestinal diseases, survivors of breast cancer or of other cancers, and women who smoke) and on the most relevant pharmacological interactions with MHT. These systematic reviews and metanalyses helped inform a structured process in which a panel of experts defined the eligibility criteria according to a specific framework, which facilitated the discussion and development process. To unify the proposal, the following eligibility criteria have been defined in accordance with the WHO international nomenclature for the different alternatives for MHT (category 1, no restriction on the use of MHT; category 2, the benefits outweigh the risks; category 3, the risks generally outweigh the benefits; category 4, MHT should not be used). Quality was classified as high, moderate, low or very low, based on several factors (including risk of bias, inaccuracy, inconsistency, lack of directionality and publication bias). When no direct evidence was identified, but plausibility, clinical experience or indirect evidence were available, "Expert opinion" was categorized. For the first time, a set of eligibility criteria, based on clinical evidence and developed according to the most rigorous methodological tools, has been defined. This will provide health professionals with a powerful decision-making tool that can be used to manage menopausal symptoms.
本项目旨在制定绝经激素治疗（MHT）的资格标准。该工具应类似于已为避孕制定的那些。由西班牙绝经学会协调的一个科学协会联盟开会制定了基于现有最佳证据的针对患有医学疾病的女性使用 MHT 的建议。该项目分两个阶段进行。作为第一步，我们就 MHT 的安全性（在九个领域：年龄、绝经开始时间、治疗持续时间、有血栓风险的妇女、有心血管疾病个人病史的妇女、有代谢综合征的妇女、有胃肠道疾病的妇女、乳腺癌或其他癌症幸存者以及吸烟的妇女）以及与 MHT 最相关的药理学相互作用进行了 14 项系统评价和 32 项荟萃分析。这些系统评价和荟萃分析有助于为一个专家小组根据特定框架定义资格标准的结构化过程提供信息，这有助于讨论和制定过程。为了统一提案，根据世卫组织国际绝经激素治疗不同替代方案的命名法（类别 1，无限制使用 MHT；类别 2，收益大于风险；类别 3，风险通常大于收益；类别 4，不应使用 MHT）定义了以下资格标准。根据几个因素（包括偏倚风险、不准确性、不一致性、缺乏方向性和发表偏倚）将质量分为高、中、低或极低。当没有直接证据时，但有合理性、临床经验或间接证据时，将其归类为“专家意见”。首次根据临床证据并按照最严格的方法学工具制定了一套资格标准。这将为卫生专业人员提供一个强大的决策工具，可用于管理绝经症状。
