EMAS Position Statements and Clincial Guides
The essential menopause curriculum for healthcare professionals: A European Menopause and Andropause Society (EMAS) position statementWomen's health is increasingly recognized as a global health priority . The menopause, or the cessation of menstruation, is a stage of the life cycle which will occur in all women. The average age at menopause is 51 years. With increasing life expectancy many women will live for several decades after the menopause. However, the menopause can occur much earlier, either naturally, with no identifiable underlying cause , or as a consequence of disease, surgery, radiotherapy or chemotherapy. The resulting estrogen deficiency may lead to menopausal symptoms which, for some, can present considerable difficulties in their working lives, discrimination in the workplace and even unemployment .
Global consensus recommendations on menopause in the workplace: A European Menopause and Andropause Society (EMAS) position statementThe menopause, or the cessation of menstruation, is a normal stage of life. The average age of the menopause is 51 years. However, it can occur much earlier, either naturally, with no identifiable underlying cause , or as a consequence of disease, surgery, radiotherapy or chemotherapy. In 2020, globally 657 million women were aged 45–59  (Fig. 1). Overall, 47% of these women worldwide contributed to the labor force, but the figures varied both regionally, ranging from 22% to 63%, as well as by age: 64%, 59%, 51%, at age 45–49, 50–54, and 55–59 respectively .
Topical estrogens and non-hormonal preparations for postmenopausal vulvovaginal atrophy: An EMAS clinical guideVulvovaginal atrophy (VVA), a component of genitourinary syndrome of menopause (GSM), is caused by estrogen deficiency. It is characterized by symptoms of dryness, burning, itching and dyspareunia . It is well established that it has a negative impact on a woman's general and sexual quality of life as well as the quality of her personal relationships . VVA is also associated with urinary tract problems, such as frequent urination, urge incontinence and recurrent urinary tract infections. GSM includes both genital and urinary symptoms .
Management of urinary incontinence in postmenopausal women: An EMAS clinical guideUrinary incontinence (UI) is defined as a “complaint of involuntary loss of urine” . The prevalence of the condition increases with age, and it is reported to affect 58%–84% of elderly women . The reported prevalence of UI varies widely because of the different definitions and assessment tools for diagnosis employed . The general prevalence is reported to be between 38 % and 55 % in women over 60 years . Despite this high prevalence, UI remains underdiagnosed and undertreated. Up to half of women may not report incontinence to their healthcare provider and this may be due to embarrassment or to the belief that UI is a normal part of aging.
The Mediterranean diet and menopausal health: An EMAS position statementWomen are living longer. The United Nations has estimated that, worldwide, 985 million women in 2020 are aged 50 and over. The figure is expected to rise to 1.65 billion by 2050 . Not surprisingly, the immediate and long-term sequelae of postmenopausal estrogen deficiency and aging present an enormous problem to healthcare systems. There are increasing concerns about non-communicable diseases (NCDs) such as cardiovascular disease (CVD), osteoporosis, dementia, and cognitive decline, which can adversely affect quality of life and independent living.
Menopause symptom management in women with dyslipidemias: An EMAS clinical guideWorldwide, dyslipidemias are one of the leading causes of cardiovascular disease, mainly coronary heart disease . Dyslipidemias are also associated with an increased risk of ischemic stroke . Dyslipidemias embrace a wide constellation of lipid and lipoprotein abnormalities. Lipoproteins bind lipids and are involved in their transport. Lipid abnormalities include high serum concentrations of low-density lipoprotein (LDL) cholesterol (LDL-C) and/or triglycerides and/or low concentrations of high-density lipoprotein (HDL) cholesterol (HDL-C).
Management of depressive symptoms in peri- and postmenopausal women: EMAS position statementThe European Menopause and Andropause Society (EMAS) aims to provide holistic consensus advice on the clinical management of menopausal women through its position statements and clinical guides . EMAS’s healthcare model for healthy menopause covers physical, psychological and social functioning, and incorporates disability and disease . This position statement sets out a model of care for the management of depressive symptoms and depressive episodes in peri- and postmenopausal women, integrating services provided by healthcare and allied professionals.
EMAS position statement: Predictors of premature and early natural menopauseTiming of menopause is an indicator of ovarian function and has important health implications. Natural menopause is commonly defined as the time when a woman has experienced 12 consecutive months of amenorrhoea without obvious cause , such as removal of both ovaries (bilateral oophorectomy), chemotherapy or radiotherapy for cancer. The International collaboration on the Life course Approach to reproductive health and Chronic disease Events (InterLACE)  recently reported that the average age at natural menopause across 21 studies from 10 countries ranged from 47 to 53 years, varying across ethnic groups from 48 years for women of South Asian background to 50 years for Caucasian women living in Australia and Europe, and 52 years for Japanese women .
Menopause and diabetes: EMAS clinical guideDiabetes mellitus (DM) is a public health problem, especially in developed countries. It affects about 9.1% of the adult population in Europe and 13.3% in the United States of America . The greater prevalence of DM in developed countries is broadly associated with ageing of the population . Between 2015 and 2030, the world population aged over 60 years is projected to increase by 56%, from 901 million to 1.4 billion; by 2050 it is expected to reach nearly 2.1 billion . These data suggest that the number of postmenopausal women with DM will grow substantially.
Current management of pelvic organ prolapse in aging women: EMAS clinical guidePelvic floor disorders include pelvic organ prolapse (POP), urinary incontinence (UI), fecal incontinence, pelvic pain and sexual dysfunction.
Calcium in the prevention of postmenopausal osteoporosis: EMAS clinical guideOsteoporosis is a chronic disease with a growing prevalence due to the increase in life expectancy . It is far more common in women than in men, and its prevalence increases markedly after the menopause. Approximately 30% of all postmenopausal women have osteoporosis in the United States and Europe, and at least 40% of these women will suffer one or more fragility fractures . As with other chronic diseases affecting modern societies, such as cardiovascular disease and cancer, risk reduction is a preferred strategy.
Drug holidays from bisphosphonates and denosumab in postmenopausal osteoporosis: EMAS position statementBisphosphonates are structural analogues of inorganic pyrophosphate, where the oxygen atom has been substituted by a carbon atom. Differences in the R2 side-chain bound to the carbon atom and the nitrogen group determine their variations in duration of action, bone affinity and anti-fracture efficacy [1,2]. Bisphosphonates inhibit enzymes involved in osteoclastic activity, and thus suppress bone resorption [1,2]. The main bisphosphonates are alendronate, risedronate, ibandronate and zoledronic acid, which constitute the first-line therapeutic agents in both postmenopausal and male osteoporosis, as they have well-documented anti-fracture efficacy [1,2].
EMAS position statement: Testosterone replacement therapy in the aging maleAging or the process of becoming older represents the accumulation of physical, psychological, and social changes in a human being over time, ultimately resulting in death. Late-onset hypogonadism (LOH) is characterized by decreasing circulating testosterone concentrations, in combination with a spectrum of clinical symptoms and signs, during normal aging .
EMAS position statement: Non-hormonal management of menopausal vasomotor symptomsTo review non-hormonal therapy options for menopausal vasomotor symptoms. The current EMAS position paper aims to provide to provide guidance for managing peri- and postmenopausal women who cannot or do not wish to take menopausal hormone therapy (MHT).
EMAS position statement: Fertility preservationThe increasing incidence of malignant diseases that often require gonadotoxic treatment and the tendency to become a parent later in life result in an increased need for fertility preservation.
EMAS position statement: Late parenthoodDuring the last decades, couples in Europe have been delaying parenthood, mainly due to socio-demographic factors that include increased rates of university education and employment in women and poorer financial status.