The Practice Pearl series is a benefit of membership in The Menopause Society and provides clinical perspectives on important menopause-related issues affecting women during the menopause transition and beyond. Practice Pearls offer an opportunity for continuing education credits and pharmacotherapeutic hours.

Topics covered include:

• Premature menopause
• Risks for cardiovascular disease
• Management of hypoactive sexual desire disorder

…and many more

Practice Pearls Examples

Here is a sneak peek at some of the topics members have access to within each issue of Practice Pearls:

The Menopause Transition: A Critical Stage for Cardiovascular Disease Risk Acceleration in Women

The menopause transition is a critical period for cardiovascular health. During this stage, women experience adverse changes in multiple components that are key for optimal cardiovascular health. Additionally, women struggle to maintain ideal health behaviors, which if adopted collectively, have been shown in observational…

Considerations for Hormone Therapy Use in Survivors of Breast Cancer

The use of hormone therapy in survivors of breast cancer is complex and contentious. Historically, guidelines have strongly advised against using hormone therapy. Its safety likely depends on many factors. However, long-term oncologic data are lacking, leaving women with unresolved quality-of-life and health concerns and practitioners uncertain about their recommendations. In the short term, there will not be definitive data, and decisions must be made based on the existing imperfect evidence.

Pharmacologic Options for the Treatment of Overweight and Obesity

The field of antiobesity pharmacotherapy is rapidly evolving. FDA-approved medications, such as orlistat, phentermine/topiramate, bupropion/naltrexone, and liraglutide, have significantly improved weight-loss outcomes. Agents such as semaglutide and tirzepatide are setting new standards, achieving weight-loss outcomes comparable to bariatric surgery. These medications not only aid in weight reduction but also offer additional health benefits, including improved cardiometabolic health and reduced cardiovascular risk. Antiobesity medications require long-term use because discontinuation often causes weight regain. Such as other chronic diseases, overweight and obesity require ongoing management. Patient education and support are key to maintaining results and preventing weight recidivism.

Oncofertility and Female Fertility Preservation: A Clinical Update

Certain cancer and medical treatments can be harmful to fertility by depleting the egg supply. The risk to fertility is dependent on the patient’s age, ovarian reserve before treatment, specific medication, or treatment and dosage. For women at risk of developing ovarian insufficiency because of gonadotoxic treatment, fertility preservation options include embryo, oocyte, and ovarian-tissue cryopreservation. Surgical procedures that can protect fertility for patients facing pelvic radiation therapy include ovarian transposition and uterine transposition. This Practice Pearl will focus on fertility preservation options for women facing medical treatment, a core component of oncofertility.

Contraception in Perimenopause

Perimenopause is characterized by wide hormone fluctuations and irregular menstrual cycles for 5 or more years preceding menopause and lasts until 12 months of amenorrhea have been achieved. It represents a period of reproductive transition with a decline in fertility. However, unintended pregnancies do occur, with a high risk for poor outcomes and maternal complications. All women transitioning through perimenopause should be adequately counseled. There are many hormone and nonhormone contraceptive methods that are highly effective and suited to the personal and medical needs of the perimenopausal woman. Contraception should continue until menopause is confirmed.

Diverse Experiences of Menopause

Although the biologic underpinnings of menopause remain consistent across populations, the experience of this phase can vary. This Practice Pearl summarizes key sociocultural, behavioral, environmental, and healthcare-system factors that contribute to the menopause journey. In addition to obtaining an accurate health history, screening for social determinants of health can enhance individualized menopause care with the potential to significantly improve overall health outcomes.

Postmenopausal Dyspareunia

Dyspareunia in the postmenopausal woman is often multifactorial and requires a thorough history, a targeted physical examination, and coordination of multiple disciplines, including medical professionals, pelvic floor physical therapists, and sex therapists. Although we have come a long way since early . . .

Neurokinin Receptor Antagonists as Potential Nonhormone Treatments for Vasomotor Symptoms 

Managing menopause symptoms is challenging for women unable or unwilling to take hormone therapy. All nonhormone options thus far have shown less overall efficacy compared with hormone therapy and significant adverse events that limit their use. New science has identified the source of vasomotor symptoms . . .

Menopause and Brain Fog: How to Counsel and Treat Midlife Women 
Brain fog, referring to menopause-related subjective cognitive difficulties, is common in midlife women. Longitudinal studies find small but reliable declines in objective memory performance as women transition into perimenopause, and these are not explained by advancing age alone. When memory declines . . .

Sexually Transmitted Infections in Midlife Women
Rates of sexually transmitted infections (STIs) are increasing in all age groups. Although STI incidence decreases with age, midlife women have risk factors that may lead to STI acquisition and underdiagnosis. Clinicians may assume that older women are not sexually active. Although many STIs are asymptomatic, when midlife women do experience vaginal symptoms, they . . . 

Fractional CO2 Laser for Genitourinary Syndrome of Menopause: Evaluating the Evidence
The fractionated CO2 laser has been marketed to women for a variety of gynecologic symptoms and conditions, including the genitourinary syndrome of menopause (GSM). The evidence has been limited, precluding conclusions regarding the efficacy and safety of the therapy. However, data from randomized, controlled trials evaluating this technology for GSM are now available. This Practice Pearl addresses the latest data concerning…

Primary Ovarian Insufficiency: A Toolkit for the Busy Clinician
Primary ovarian insufficiency (sometimes known as premature ovarian insufficiency) is a result of loss of ovarian follicular activity before the age of 40 years. It is an endocrine deficiency state in women, characterized by premature estrogen deprivation. In the absence of estrogen replacement, women experience…

Reproductive Risk Factors for Cardiovascular Disease in Women
Cardiovascular disease (CVD) remains the leading cause of death for women. Adverse pregnancy outcomes, including hypertensive disorders of pregnancy, gestational diabetes mellitus, preterm delivery, and low birth weight—affecting up to 30% of pregnant women—increase the risk of CVD. Early menarche and polycystic…

Evaluation and Treatment of Vulvovaginal Itching in Postmenopausal Women

Vulvovaginal itching, a commonly reported symptom in postmenopausal women, may be because of the genitourinary syndrome of menopause but has a broad differential including dermatologic, infectious, and autoimmune causes. Comprehensive evaluation is important to avoid inappropriate treatments…

Testosterone Use for Hypoactive Sexual Desire Disorder in Postmenopausal Women

Testosterone is an important evidence-based therapy for hypoactive sexual desire disorder (HSDD) in postmenopausal women. Clinical practice guidelines based on the most comprehensive meta-analysis of benefits and risks of testosterone therapy to date state that the sole evidence-based indication for testosterone…

Clinical Considerations for Menopause and Associated Symptoms in Women With HIV

Worldwide, more women with HIV are aging and entering menopause. Although a limited number of evidenced-based care recommendations are published, formal guidelines for the management of menopause in women with HIV are not available. Many women with HIV receive primary care from HIV infectious…

Aspirin for Primary Prevention of Cardiovascular Disease in Women

Aspirin use for primary prevention of cardiovascular disease is controversial. Low-dose aspirin may be considered for primary prevention in women on an individualized basis for those aged 40 to 59 years with a 10-year cardiovascular risk of 10% or more and without increased bleeding risk. Low-dose aspirin…

…and many more