EMAS Position Statements and Clincial Guides
- Life 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 .
- Women'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 .
- 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 .
- Breast 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).
- 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.
- 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.
- 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.
- There is emerging evidence on the widespread tissue effects of vitamin D.