International Menopause Society (IMS) recommendations and key messages on women’s midlife health and menopause

Following a rigorous systematic review of the literature, the International Menopause Society (IMS) has produced detailed new recommendations and key messages on women’s midlife health, menopause and menopause hormone therapy (MHT) to help guide healthcare professionals to optimize their support and guidance to women at this critical stage of life. The term MHT has been used to cover therapies including estrogens, progestogens, gonadomimetics and combined regimens. This guidance provides a summary of the recommendations and key messages generated from the systematic review process. The longer version, including the detailed text, key meta-analyses, references, figures and supplementary materials, will be published simultaneously online and can be accessed via the IMS website (https://www.imsociety.org/statements/ims-recommendations/). The quality of evidence and the strength of recommendations used in this guideline are based on the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) and the Appraisal of Guidelines for Research & Evaluation II (AGREE II) approaches. The new recommendations now include levels of evidence, grades of recommendations, good practice points and key messages. The recommendations were developed by a body of 38 authors and 27 support team members derived from the IMS and other organizations. Global stakeholder surveys, targeted at both healthcare providers and consumers, were initially conducted to identify the key questions. A Publication Steering Committee (PSC) provided oversight of the process through regular meetings and ensured consistency of methodology. By the end of the process, 30 completed sections were submitted by the authors to individual lead reviewers selected from the PSC to provide peer review and finally endorsed by the PSC, IMS board and stakeholders. Overall, 342 recommendations (285 supported by research data and 57 good practice points) and 40 key messages have been formulated. These span a diverse range of health topics, including lifestyle, midlife body changes, vasomotor symptoms, genitourinary syndrome of menopause, osteoporosis, cardiometabolic health, dementia, premature ovarian insufficiency and various malignancies. A new section addresses the often-overlooked topic of sarcopenia which requires urgent attention. Current controversial topics, such as the influence of the media, the role of the pharmaceutical industry and publication ethics, are also explored. The overall aim of these recommendations and guidelines is to provide the blueprint for support and guidance to women on midlife health and menopause, given the latest available evidence. In preparing these international recommendations, experts have endeavored to consider geographical variations in medical care, prevalence of diseases/conditions, symptom severity, availability and licensing of MHT and alternatives, and country-specific attitudes of the public, medical community and health authorities towards menopause management.