EMAS Position Statements and Clincial Guides
Menopause, wellbeing and health: A care pathway from the European Menopause and Andropause Society
Life expectancy has considerably increased since 1970 [1], and now >50% of women are expected to break the 90-year barrier by 2030 [2]. Growing older rather than old means spending almost half of life after the menopause, challenging the concept of healthy ageing [3]. 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 [4].The essential menopause curriculum for healthcare professionals: A European Menopause and Andropause Society (EMAS) position statement
Women's health is increasingly recognized as a global health priority [1]. 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 [2], 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 [3].Global consensus recommendations on menopause in the workplace: A European Menopause and Andropause Society (EMAS) position statement
The 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 [1], or as a consequence of disease, surgery, radiotherapy or chemotherapy. In 2020, globally 657 million women were aged 45–59 [2] (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 [3].Topical estrogens and non-hormonal preparations for postmenopausal vulvovaginal atrophy: An EMAS clinical guide
Vulvovaginal 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 [1]. 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 [2]. 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 [1].Management of urinary incontinence in postmenopausal women: An EMAS clinical guide
Urinary incontinence (UI) is defined as a “complaint of involuntary loss of urine” [1]. The prevalence of the condition increases with age, and it is reported to affect 58%–84% of elderly women [2]. The reported prevalence of UI varies widely because of the different definitions and assessment tools for diagnosis employed [3]. The general prevalence is reported to be between 38 % and 55 % in women over 60 years [4]. 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 statement
Women 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 [1]. 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.European Menopause and Andropause Society (EMAS) and International Gynecologic Cancer Society (IGCS) position statement on managing the menopause after gynecological cancer: focus on menopausal symptoms and osteoporosis
Worldwide, it is estimated about 1.3 million new gynecological cancer cases are diagnosed each year. For 2018 the predicted annual totals were cervix uteri 569,847, corpus uteri 382,069, ovary 295,414, vulva 44,235 and vagina 17,600 [1].Management of depressive symptoms in peri- and postmenopausal women: EMAS position statement
The 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 [1]. EMAS’s healthcare model for healthy menopause covers physical, psychological and social functioning, and incorporates disability and disease [2]. 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 menopause
Timing 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 [1], 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) [2] 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 [3].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 model
Estrogen deficiency due to menopause affects a woman on all levels, from subcellular structures, organs, regulatory systems to bio-mental-psycho-social functioning [1]. 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) [2]. 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 [3].Menopause and diabetes: EMAS clinical guide
Diabetes 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 [1]. The greater prevalence of DM in developed countries is broadly associated with ageing of the population [2]. 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 [3]. 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 guide
Pelvic 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 guide
Osteoporosis is a chronic disease with a growing prevalence due to the increase in life expectancy [1]. 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 [2]. As with other chronic diseases affecting modern societies, such as cardiovascular disease and cancer, risk reduction is a preferred strategy.A model of care for healthy menopause and ageing: EMAS position statement
The menopause can now be considered to be a mid-life event as the lifespan of women continues to increase in developed countries [1]. 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) [5], 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 women
Occupational 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 [1]. 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 male
Aging 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 [1].EMAS position statement: Non-hormonal management of menopausal vasomotor symptoms
To 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: The ten point guide to the integral management of menopausal health
With increased longevity and more women becoming centenarians, management of the menopause and postreproductive health is of growing importance as it has the potential to help promote health over several decades. Women have individual needs and the approach needs to be personalised. The position statement provides a short integral guide for all those involved in menopausal health. It covers diagnosis, screening for diseases in later life, treatment and follow-up.EMAS position statement: Individualized breast cancer screening versus population-based mammography screening programmes
Breast cancer originates from the malignant transformation of epithelial cells within the ducts and lobules of the breast. A malignant cell is the result of the accumulation of consecutive mutations. Up or down regulation of different mutated genes will ultimately result in the heterogeneity of breast cancers [1]. Some tumors will remain in situ and will never threaten the health of women. Other tumors will become invasive and ultimately metastasize and hence be fatal when not treated. The doubling time of tumor cells is estimated between 150 and 200 days [2].EMAS position statement: Management of uterine fibroids
Uterine fibroids (also termed leiomyomas or myomas) are the most common tumors of the female reproductive tract.EMAS position statement: The management of postmenopausal women with vertebral osteoporotic fracture
Osteoporotic vertebral fractures are associated with significant morbidity, excess mortality as well as health and social service expenditure. Additionally, women with a prevalent osteoporotic vertebral fracture have a high risk of experiencing a further one within one year. It is therefore important for the physician to use a diagnostic and therapeutic algorithm for early detection and effective treatment of vertebral fractures.EMAS position statement: Menopause for medical students
Discussions with patients about the menopause are becoming more complex because of women's increasing longevity, the wide range of therapeutic options, the controversies regarding menopausal hormone therapy (MHT) and the increasing use of alternative and complementary therapies. The aim of this document is to provide guidance in bullet-point style on the essential issues that medical students need to know about the stages of reproductive aging, menopause terminology, menopause and postmenopausal health [1].EMAS position statement: Fertility preservation
The 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 parenthood
During 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.
