The recommendations are listed in 3 tiers:
- Level A ("good or consistent scientific evidence"):
- Systemic HT, with just estrogen or estrogen plus progestin, is the most effective approach for treating vasomotor symptoms.
- Low-dose and ultra-low systemic doses of estrogen have a more favorable adverse effect profile than standard doses.
- Healthcare providers should individualize care and use the lowest effective dose for the shortest duration.
- Thromboembolic disease and breast cancer are risks for combined systemic HT.
- Selective serotonin reuptake inhibitors, selective serotonin and norepinephrine reuptake inhibitors, clonidine, and gabapentin relieve vasomotor symptoms and are alternatives to HT.
- Local estrogen therapy is advised for isolated atrophic vaginal symptoms.
- The only nonhormonal therapy approved to treat vasomotor symptoms is paroxetine, and to treat dyspareunia is ospemifene.
- Level B conclusions ("limited or inconsistent scientific evidence"):
- Data do not support use of progestin alone, testosterone, compounded bioidentical hormones, phytoestrogens, herbal supplements, and lifestyle modifications.
- "Common sense lifestyle solutions" are layering clothing, lowering room temperature, and consuming cool drinks.
- Nonestrogen water-based or silicone-based lubricants and moisturizers may alleviate pain.
- Level C recommendation ("based primarily on consensus and expert opinion"):
- Individualize the decision to continue HT.