Eligibility criteria for the use menopausal hormone therapy (MHT) in women with medical conditions (II): Endometriosis, neurological and autoimmune diseases

Abstract

This project developed eligibility criteria for menopausal hormone therapy in patients with medical conditions beyond those published in a previous report. A new consortium of scientific societies coordinated by the Spanish Menopause Society met to develop recommendations for the use of menopausal hormone therapy in patients with some medical conditions based on the best available evidence.

The project was developed in two phases. As a first step, we conducted six systematic reviews and three meta-analyses on the safety of menopausal hormone therapy, addressing six clinical questions related to rheumatoid arthritis, systemic lupus erythematosus, antiphospholipid syndrome, multiple sclerosis, Parkinson's disease, and endometriosis.

In the second step, the six systematic reviews and three meta-analyses (one on lupus erythematosus and two on Parkinson's disease) helped inform a structured process in which a panel of experts defined the eligibility criteria according to a specific framework, which facilitated the discussion and development process. The eligibility criteria were defined in accordance with the World Health Organization's international nomenclature for the categories of use of menopausal hormone therapy:

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  Category 1: No restriction on the use
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  Category 2: The benefits outweigh the risks.
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  Category 3: Risks generally outweigh benefits.
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  Category 4: menopausal hormone therapy should not be used.

The quality of evidence was classified as high (A), moderate (B), low (C), or very low (D).

For the first time, a set of eligibility criteria, based on clinical evidence and developed according to the most rigorous methodological tools, has been defined. This will provide health professionals with a decision-making tool that can be used to manage menopausal symptoms.