Highlights
- •Significant limitations were identified in the quality of menopause guidelines.
- •Menopause guidelines vary in regard to content and details of recommendations.
- •Consensus was observed between high scoring guidelines for some EM/POI recommendations.
Abstract
Objectives
Clinical practice guidelines (CPGs) are systematically developed statements that guide
clinicians to provide appropriate healthcare. The aims of this study were: 1) to systematically
evaluate the quality of menopause management CPGs; 2) to identify menopause topics
included in the CPGs; 3) to summarize the recommendations regarding either early menopause
(EM) or premature ovarian insufficiency (POI) provided by high-scoring CPGs; and 4)
to develop EM/POI management algorithms.
Study design
A systematic search for CPGs published between 2012 and 2017 was conducted using Medline,
Embase, All EBM, CPG databases and medical websites. Appraisal was conducted by 4
independent reviewers using the Appraisal of Guidelines for Research & Evaluation
II instrument (AGREE II). Inter-rater reliability was calculated using the intraclass
correlation coefficient. Recommendations regarding EM/POI were extracted from high-scoring
CPGs and translated into a management algorithm, which was refined on the basis of
feedback from expert clinicians.
Results
The systematic search yielded 22 CPGs for review. Only 2 were assessed as high quality,
with 10 average and 10 considered low quality. Scope and purpose (73% ± 15%) and clarity
of presentation (78% ± 15%) achieved the highest mean scores, while applicability
scored the lowest (23% ± 18%). Inter-rater agreement was 0.74 (good) to 0.91 (very
good). The most comprehensive CPGs were those developed by the National Institute
for Health and Care Excellence (NICE), the International Menopause Society (IMS) and
the European Menopause and Andropause Society (EMAS).
Conclusions
Most menopause CPGs are poor to average quality and there is variation between them
in EM/POI management recommendations. EM/POI management algorithms were developed
from high-scoring CPGs.
Keywords
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Article info
Publication history
Published online: September 22, 2019
Accepted:
September 20,
2019
Received in revised form:
September 3,
2019
Received:
May 13,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
