EMAS Position Statements and Clincial Guides
Menopause, wellbeing and health: A care pathway from the European Menopause and Andropause SocietyLife expectancy has considerably increased since 1970 , and now >50% of women are expected to break the 90-year barrier by 2030 . Growing older rather than old means spending almost half of life after the menopause, challenging the concept of healthy ageing . Iatrogenic menopause may be induced by cancer treatment or bilateral salpingo-oophorectomy for benign disease and may occur before the average age of natural menopause, which is around the age of 50 [4,5]. The sudden fall in estrogen levels with iatrogenic menopause may lead to rapid onset of vasomotor symptoms .
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 .
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 .
Linking the menopause rating scale to the International classification of functioning, disability and health – A first step towards the implementation of the EMAS menopause health care modelEstrogen deficiency due to menopause affects a woman on all levels, from subcellular structures, organs, regulatory systems to bio-mental-psycho-social functioning . Accordingly, various (non)specific symptoms may occur, called climacteric syndrome. Despite its multidimensional phenotype is has been classified only unidimensionally so far using the ICD-10 (N95) . Recently, the European Menopause and Andropause Society (EMAS) proposed a new Healthy Menopause Health Care Model which aims to set up a personalized care plan for short-, mid- and long-term goals in the context of physical, psychological and social functioning .
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].
Interventions to reduce the risk of ovarian and fallopian tube cancer: A European Menopause and Andropause Society Position StatementApproximately 1.3% of women will be diagnosed with ovarian cancer at some point during their life. Mortality is high, with a 5-year survival rate ranging from 36% to 46%, although there has been a net survival improvement during the last decades, especially among young and mid-aged women [1,2].
Osteoporosis management in patients with breast cancer: EMAS position statementBreast cancer remains the most frequent cancer in women and its incidence is increasing. However, the mortality rate has stabilized due to the progress made in the treatment of breast cancer over the last decade. In premenopausal women with hormone receptor-positive breast cancer, the goal of adjuvant treatment is to inhibit the impact of estrogen on the breast, either by blocking the estrogen receptors (with the use of tamoxifen) or by suppressing ovarian function (through surgical oophorectomy or treatment with luteinizing hormone-releasing hormone (LHRH) agonist).
A model of care for healthy menopause and ageing: EMAS position statementThe menopause can now be considered to be a mid-life event as the lifespan of women continues to increase in developed countries . By the year 2025, the number of postmenopausal women is expected to rise to 1.1 billion worldwide. Although not all women will experience short- or long-term problems of menopause, the high prevalence of hot flushes [2,3] and vaginal atrophy [2,4], which can last for many years, as well as osteoporosis (1 in 3 women are at risk of an osteoporotic fracture) , makes caring for ageing women a key issue for health professionals.
Maintaining postreproductive health: A care pathway from the European Menopause and Andropause Society (EMAS)This position statement from the European Menopause and Andropause Society (EMAS) provides a care pathway for the maintenance of women’s health during and after the menopause. It is designed for use by all those involved in women’s health. It covers assessment, screening for diseases in later life, treatment and follow-up. Strategies need to be optimised to maintain postreproductive health, in part because of increased longevity. They encompass optimising diet and lifestyle, menopausal hormone therapy and non-estrogen-based treatment options for climacteric symptoms and skeletal conservation, personalised to individual needs.
EMAS recommendations for conditions in the workplace for menopausal womenOccupational health issues for older workers in general, and older women workers in particular, have often been ignored. Women form a large part of many workforces throughout Europe. The number of persons in employment in EU Member States rose between 2013 and 2014 by around 2.3 million, to 217.8 million in 2014 . The employment rate for men was just over 70%, and for women, nearly 60%. A longer-term comparison shows that while the employment rate for men in 2014 was below its corresponding level ten years earlier, there was a marked increase in the proportion of women in employment.
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 .