Menopause Management

Last Updated: October 14, 2025

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This tool is designed to support primary care clinicians in screening, diagnosing and implementing treatment for women and people experiencing perimenopause, menopause and post-menopause. Although a natural transition, menopause is often under-recognized in healthcare and can have a significant impact on a person’s life and long-term health. Primary care is an important setting to normalize this life stage, provide evidence-based care, and reduce the stigma surrounding it and to improve quality of life and long-term health.

Important Considerations1-4

  • Menopause affects half the population, yet many are unprepared for it.
  • The economic and personal costs of unmanaged symptoms of menopause are significant. An estimated 1 in 10 women leave the workforce due to unmanaged symptoms resulting in an annual economic loss of $3.5 billion in Canada. The personal toll includes lost income, stalled career progression and reduced self-esteem.
  • Symptoms are common and can be long-lasting. The average age of menopause onset is 51, with 90% of women experiencing it between the ages of 45 and 56. Vasomotor symptoms (VMS) affect about 80% of women and can last for an average of 7-11 years. Genitourinary Syndrome of Menopause (GSM) affects 45-77% of women, with symptoms that often worsen over time and persist if untreated.
  • There are sociocultural differences in age of onset and severity of symptoms.
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Assessment

Jump to:

The menopause journey5-7

  • Understanding what stage of menopause the individual is in will help influence management options.
  • Perimenopause, also known as “the menopause transition”, begins when people experience menopause-associated symptoms and/or can be accompanied by changes in their menstrual cycle. It is an important time for preventative care, as it can be associated with increased risk of cardiovascular disease and bone loss.
    • This stage can last up to 10 years and can be divided into two phases – early and late. Early perimenopause is associated with more fluctuations of estrogen, whereas late perimenopause is associated with a steadier decline in estrogen until menopause.
  • Premature menopause occurs when menopause happens before the age of 40 and should be evaluated for primary ovarian insufficiency (POI).
  • Early menopause occurs between ages 40 and 45.
  • Menopause is when a person has not had a period for at least 12 months and is not on hormonal contraception.
  • Post-menopause refers to the time of life from the onset of menopause until the end of life.
  • Menopause can be induced either surgically (e.g., bilateral oophorectomy) or medically (e.g. chemotherapy, radiation).7

The term women and people experiencing perimenopause and menopause is inclusive of all individuals who will experience perimenopause and menopause, including women, Two-Spirit people, trans men, and nonbinary people assigned female at birth.6

Talking tips
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The menopause journey

Talking tips10

“Many people think of ‘menopause’ as a single event, but it’s a natural and significant transition in your life – a journey that unfolds over several years. This journey, often starting with perimenopause, can feel unique for each person, and however you’re experiencing it is completely valid. My role is to partner with you, listen to your experience, and together, we’ll find the best ways to manage your symptoms and support your long-term health through this important time.”

“You may have heard about the Women’s Health Initiative (WHI) study, which caused a lot of fear about MHT. While the study initially suggested increased risks with hormone therapy, the evidence has since proven that hormone therapy is generally safe and effective when started at the right time and with proper consideration of your health history.

This tool aims to empower and guide primary care clinicians in managing menopause within the primary care setting. For additional support consider consulting specialists across the province at OTN eConsult.

Screening6

Consider screening individuals who are ≥ 40 years for menopause-associated symptoms. Symptoms can include:

  • Changes in menstrual cycle (may become irregular in timing, flow, or length)
  • Vasomotor symptoms (VMS), such as hot flashes or night sweats
  • Symptoms of Genitourinary Syndrome of Menopause (GSM):
    • Vaginal dryness
    • Discomfort with sexual intercourse
    • Vulvovaginal discomfort or irritation
    • Discomfort, pain or urgency associated with urination
    • Frequent urinary tract infections, incontinence
  • Sexual difficulties, such as low sexual desire
  • Mood changes, such as depressive symptoms or anxiety
  • Musculoskeletal symptoms, such as joint and muscle pain
  • Sleep disturbances
  • Changes in weight and/or body fat distribution
  • Difficulties with concentration or memory (i.e., brain fog)
  1. Any changes in your periods?
  2. Are you having any hot flashes?
  3. Any vaginal dryness or pain or sexual concerns?
  4. Any bladder issues or incontinence?
  5. How is your sleep?
  6. How is your mood?

Diagnosis10

  • Identification of perimenopause or menopause is a clinical diagnosis, based on the menopause-associated symptoms that the person is experiencing. Routine lab work is not required.
  • Conduct a thorough evaluation with detailed history including family, obstetrics, gynaecological, cancer, menstrual and sexual history.
  • For those experiencing GSM, a physical exam is helpful to differentiate between hormonal (e.g., vulvo-vaginal atrophy) and non-hormonal (e.g., lichen sclerosis, lichen planus) causes and guide treatment.
    • A pre-exam is not a prerequisite for prescribing treatment, but if symptoms are ongoing, consider an in-person review/examination.
  • It can be difficult to identify menopause in women and people who are taking hormonal treatments (e.g., birth control pills/IUS).

The following laboratory and imaging tests should not be used to identify perimenopause or menopause in people aged 40 or over6,7: 

  • Anti-Müllerian hormone 
  • Inhibin A 
  • Inhibin B 
  • Estradiol 
  • Antral follicle count
  • Ovarian volume

Note: While not necessary to do a FSH and estradiol routinely to diagnose menopause in individuals over 40, these tests can be considered if there is a history of hysterectomy or IUD that makes diagnosis difficult.11

What is Premature Ovarian Insufficiency (POI)?
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Premature Ovarian Insufficiency (POI)12
  • Premature Ovarian Insufficiency (POI) is a condition in which the ovaries stop producing eggs before the age of 40.
  • It is under-diagnosed and has significant impact on an individual’s health.
  • While symptoms are similar to menopause (e.g. irregular periods, hot flashes, night sweats), POI requires further investigation to determine etiology.
  • Management of POI often requires higher doses of hormone therapy than standard menopause treatment and is recommended from the time of diagnosis to at least the average of menopause, due to the significant impact on CVD, brain and bone health.
  • POI is characterized by11:
    • Oligo/amenorrhoea (infrequent menstrual periods, typically with cycles longer than 35 days amenorrhea > 4 months).
    • FSH >25 IU/l represents a value greater than the physiological peak observed in premenopausal women and will encompass women with POI due to autoimmune causes.
    • Fluctuating ovarian activity may occur resulting in variable FSH concentrations, including into the normal range. While guideline does not suggest a repeat FSH, this can be helpful for individuals to understand the diagnosis.
    • Estrogen levels tend to be low.
    • Negative serum BHCG.
  • If diagnosis is made, consider referring to specialist for fertility (if desired), endocrinology, or genetics for additional care and support.
Resources
Clinician resources
Patient resources

Management

Jump to:

Pharmacological therapy

Menopausal hormonal therapy (MHT) for vasomotor symptoms5,7,10,11,13

Menopausal hormone therapy (MHT) is one of the most effective options for managing vasomotor symptoms in women and people experiencing menopause and perimenopause. MHT can be safely initiated in individuals without contraindications who are younger than 60 years of age or within 10 years of menopause. Ensure routine screening (e.g., mammograms, cholesterol, lipoprotein(a), HbA1c,  relevant blood work) is completed.

A shared decision-making approach is a vital ongoing process involving individuals, their care team, family and caregivers.

Primary care clinicians initiating MHT should ensure it is individualized and consider the following when determining dose and duration:

  • Ongoing symptoms and impact on quality of life
  • Age at presentation
  • Individual preferences and treatment goals
  • Cost of treatment
  • Medical history
  • Health benefits and risks
  • Family history
  • Timing of last menstrual period
  • Review for possible contraindications
What benefits to expect and when​
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What benefits to expect and when 5,7,10,11​

GSM

Vaginal estrogen:​

  • Studies show a 50% response rate with estragel softgel inserts compared to a 40% response rate with a placebo (lubricants and moisturizers)
  • Timeframe: ​
    • Some benefits at 2 weeks ​
    • Full effects at 8 weeks
VMS

Oral or transdermal estrogen (rating “improved” or “very much improved”) at 12 weeks: ​

  • Baseline: 10-13 hot flashes/day
  • Placebo: 3-6 fewer
  • Lower dose estradiol 7-8 fewer
  • Higher dose estradiol 8-9 fewer​
  • Timeframe:​
    • Some benefits at 1 week ​
    • Majority of effects at 6-9 weeks

Fezolinetant (“moderately or much better” – 12 weeks)​

  • Baseline: 11 hot flashes/day, placebo 4 fewer, fezolinetant 7 fewer
  • Timeframe:​
    • Some benefits at 1 week ​
    • Majority of effects at 6 weeks

 

Contraindications to systemic menopausal hormone therapy include the following:6

Contraindications to estrogen:

  • Undiagnosed abnormal vaginal bleeding
  • Active breast cancer, suspected breast cancer, or a personal history of breast cancer
  • Active estrogen-dependent cancers or suspected estrogen-dependent cancers (i.e., endometrial, ovarian)
  • Coronary heart disease
  • Active venous thromboembolism or history of venous thromboembolism
  • Active stroke or history of stroke
  • Known thrombophilia
  • Active liver disease
  • Known or suspected pregnancy
  • Uncontrolled hypertension

Contraindications to progestogen:

  • Undiagnosed abnormal vaginal bleeding
  • Active breast cancer or personal history of breast cancer

Compounded bioidentical hormone therapy is not approved by Health Canada, is not considered standard of care, and should not be offered in place of Health Canada approved, pharmaceutical-grade menopausal hormone therapy.6

Note: Clonidine and pregabalin are no longer used for treatment as there are more effective treatment options available.

Perimenopause6,7,10

For women and people experiencing perimenopause, contraceptive needs and bleeding patterns must be discussed when considering options. Based on individual symptoms and goals of care, consider the following options:

  • Low dose combined hormonal contraceptives
  • MHT (estrogen) in combination with a levonorgestrel-releasing intrauterine system (IUS)
  • MHT with a cyclical progestogen for 12 – 14 days/month (prefer cyclic early perimenopause to reduce risk of irregular bleeding)
  • Progestogen only (i.e., drosperinone)
GSM6,13,14
  • ~25% of individuals on systemic MHT may have ongoing GSM symptoms and would benefit from additional local treatment options.
  • If the only symptom of concern is GSM, management can be focused on local treatment only.
  • For women and people experiencing moderate to severe GSM, local vaginal estrogen is first line treatment, administered either as a cream, tablet, or sustained-release ring.
  • Unlike systemic hormonal therapy, local vaginal estrogen therapy can be initiated at ANY age and continued indefinitely.
  • For mild symptoms or in combination with hormone and non-hormonal treatments:
    • Vaginal lubrication (reduces friction during intercourse and can be used as needed) or moisturizers (regular application required, provides more continuous relief than lubricants).
  • If non-hormonal or local estrogen options have been ineffective, impractical or not desired, consider either adding or replacing with:
    • Vaginal dehydroepiandrosterone (DHEA) ovules
    • Oral selective estrogen receptor modulator (Ospemifene) to support treatment of dyspareunia
  • When symptoms are not relieved or physical exam reveals non-hormonal causes, treat or refer accordingly.
Sexual health6,16
  • Sexual dysfunction in menopausal individuals should be categorized as being related to desire, arousal, pain and orgasm.
  • Hypoactive sexual desire disorder (HSDD): Persistent lack of sexual desire for ≥6 months that causes distress and cannot be explained by another condition.
    • For postmenopausal individuals with HSDD consider managing pain, addressing biopsychological factors and counselling.
  • Testosterone supplementation can be offered to individuals with low sexual desire associated with menopause.

Practice point

Abnormal uterine bleeding7,11

Breakthrough bleeding is a common side effect of MHT. It is common to see bleeding up to 6 months after starting continuous MHT. Heavy bleeding or continued breakthrough bleeding after 6 months requires further investigation. If risk factors for endometrial cancer exist (PCOS, obesity, Lynch syndrome), investigate earlier than 6 months.

Talking tips
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Talking tips10

“When it comes to managing your menopausal symptoms, there are many good options, and what’s right for one person isn’t always right for another. My role is to help you understand all of the options available, both hormonal and non-hormonal, and what they involve and their benefits. Let’s explore these together and decide on the best path forward that aligns with your symptoms, your health and your preferences.”

“If we decide that Menopausal Hormone Therapy (MHT) is a good option, you should start to feel the effects on some symptom relief within a few weeks, but can take up to 12 weeks to work fully. It’ll depend on the dosage we start with, and we may need to adjust it along the way to find what works best for you.”

Addressing treatment costs

  • “Before we finalize a treatment plan, let’s make sure it’s both effective and affordable for you.”
  • “Do you have a prescription drug plan? Knowing your coverage helps us choose the right option.”
  • “We can discuss programs like the Trillium Drug Program if you are eligible, or other ways to make sure you get the medication you need.”

OHIP billing code: Use code “627 – Menopause, post-menopausal bleeding”17

Systemic and local MHT

Non-hormonal therapy7,10,18

For individuals who have contraindications or prefer alternatives to hormone therapy, non-hormonal prescription therapies can be considered. While these have shown efficacy in VMS relief, results vary with each option having their own adverse effects. It is important to flag that estrogen is still the most effective therapy for vasomotor symptom relief.

Non-hormonal therapies include:

  • Neurokinin B antagonist (Fezolinetant, Elinzanetant)
  • Gabapentin
  • Oxybutynin
  • Selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs)

Non-pharmacological therapy6,7

  • Vasomotor and non-vasomotor symptoms experienced during perimenopause or menopause can affect quality of life.
  • Evidence-based lifestyle interventions in managing VMS symptoms include:
    • CBT
    • Hypnosis
  • Prioritizing lifestyle changes can help improve quality of life, mental health, CVD and bone health:
    • Weight management
    • Blood pressure management
    • Smoking cessation
    • Minimizing alcohol
    • Physical activity including strength training
    • Healthy diet (limiting caffeine, diet high in fibre, protein, unsaturated fats)
    • Good sleep hygiene
Talking tips
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Lifestyle changes

It is important to use neutral language when discussing lifestyle changes and to meet the individuals where they are at:

Lifestyle adjustments can significantly help manage your symptoms and improve your well-being.

  • “Consistent movement, even daily walking, supports mood, sleep and bone health. What kinds of activities could you include in your routine?”
  • “Good nutrition can stabilize energy. Are there any dietary changes you’d like to explore?”
  • “Improving your sleep is crucial. We can review your habits to see if small changes, like optimizing your sleep environment, could help you get better rest.”

Referrals6

Consider referral to clinicians with expertise in menopause when there are:

  • No improvement in symptoms with treatment, or continued side effects.
  • Contraindications to menopausal hormone therapy.
  • Premature menopause or POI.
  • Menopause-associated symptoms in a person who has taken gender-affirming hormone therapy in the past.

Considerations for specific populations and symptoms New

Considerations for specific populations

  • Assess breast cancer risk to help with shared decision-making treatment options. Consider using the My CancerIQ assessment.
  • Systemic MHT is contraindicated in people with a history of breast cancer. Instead, non-hormonal and non-pharmacologic options can be used.
  • Genitourinary symptom management for people with a history of breast cancer:
    • Non-hormonal options – vaginal moisturizers, lubricants, pelvic floor physiotherapy, dilators or vibrators
    • Local vaginal estrogen can be considered for individuals with breast cancer in consultation with an oncologist.
  • Vasomotor symptom management for people with a history of breast cancer:
    • Non-hormonal options – CBT, hypnosis
    • First line non-hormonal option – Neurokinin B receptor antagonists (fezolinetant, elinzanetant), desvenlafaxine/venlafaxine
    • Second line non-hormonal option – paroxetine (avoid in individuals on tamoxifen), gabapentin, oxybutynin
  • For individuals with an active or history of breast cancer, encourage individuals to talk to their oncologist about their treatment options.
  • MHT, while primarily used for vasomotor symptom relief, can prevent bone loss and reduce fracture risk in post-menopausal individuals, if the following criteria are met:
    • < 60 years
    • No history of breast cancer or thromboembolic disease or cardiovascular disease
    • Low risk of cerebrovascular disease
    • Pharmacological treatment of osteoporosis to reduce fracture risk is indicated
      • Consider using the FRAX tool and/or bone mineral density testing (BMD) to determine fracture risk.
  • Encourage all postmenopausal individuals to employ lifestyle practices that reduce the risk of bone loss and osteoporotic fractures:
    • Maintain a healthy weight.
    • Eat a balanced diet.
    • Adequate protein, calcium and vitamin D. Routine supplementation with protein, vitamin K, or magnesium is not recommended for fracture prevention. Supplements should only be used when daily targets are not achieved from dietary sources.
    • Participate in regular physical activity that includes weight-bearing exercise and stability training for fall prevention.
    • Avoid excess alcohol consumption.
    • Do not smoke.
    • Implement measure to prevent falls.

 

Mood

  • People experiencing perimenopause can develop depressive symptoms, even without a previous history, due to factors caused by menopause (e.g., hormonal changes, vasomotor symptoms, poor sleep) and lifestyle factors.
  • It is also common for depression to resurface for individuals who have had it in the past.
  • Assess for severity and impact on daily living and rule out other possible conditions contributing to change in mood.
  • Choice of antidepressants should be based on:
    • Individual’s response and tolerability.
    • Potential adverse effects that may influence other concerns (i.e. weight, sexual dysfunction).
    • Drug to drug interactions and contraindications.
  • Non-pharmacologic treatment options – CBT, counselling, lifestyle modifications.
  • As vasomotor symptoms can contribute to disruption in sleep and mood, MHT may improve mood when used as treatment for vasomotor symptoms.

Sleep

  • Changes in sleep quality are common among women and people in the perimenopausal and postmenopausal periods.
  • Primary sleep disorders (e.g., night terrors, obstructive sleep apnea) should be ruled out before recommending treatment.
    • E.g., CBT for insomnia, education on sleep hygiene (i.e., limiting alcohol, caffeine, nighttime exercise, screens in bedroom)
  • As vasomotor symptoms can contribute to disruption in sleep and mood, MHT may improve mood when used as treatment for vasomotor symptoms.

Cognition

  • During the menopause transition, people can experience cognitive changes that are often temporary. These often include:
    • Worsening memory
    • Slower cognitive speed (i.e., brain fog)
  • It is important to rule out mood disorders, thyroid dysfunction, vitamin B12 deficiency and iron deficiency. If identified, treat appropriately.
    • Can use screeners such as MOCA, Conners’ Adult rating scale, Adult ADHD self-report rating scale to diagnose and demonstrate transience of symptoms.
  • Cognitive function can improve by modifying lifestyle factors such as optimizing sleep, managing mood and engaging in regular exercise.

 

See Non-pharmacological section for more details on treatment options

  • During perimenopause and the menopause transition, cardiovascular risk factors often worsen. Clinicians should be proactive in identifying and modifying risk factors as the most effective means of reducing cardiovascular risk. This includes screening for blood pressure, A1C, lipids and lipoprotein(a).
  • Currently, MHT is not indicated as a method for prevention of CVD.  However, to support risk reduction of CVD alongside other treatment options, women and people with premature menopause should be prescribed estrogen (+ progesterone if intact uterus) replacement therapy until the average age of menopause (51 years).
  • If there is a history of coronary artery disease, encourage individuals to talk to their cardiologist about menopause hormone therapy when discussing their treatment options.

Cardiac event risk of MHT

  • The risk of cardiac event is small and is not considered statistically significant for women within the 50-60 age range.

Stroke risk of MHT

  • The overall risk of stroke associated with systemic estrogen is low.
  • Risk prevention – the lowest effective dose of systemic estrogen (oral or transdermal) should be prescribed.

Venous Thrombotic Events (VTE) of MHT

  • MHT increases the risk of venous thrombotic events (e.g., deep vein thrombosis, pulmonary embolism).
  • There is a higher risk of VTE with oral and combined hormone therapy preparations than transdermal preparations or estrogen alone.
  • Risk reduction – the lowest effective dose of systemic transdermal estrogen and estrogen-only therapy should be considered.

 

Practice point22

Beyond vasomotor symptoms, estrogen therapy may improve sleep and mood symptoms in perimenopausal women. Evidence suggests a possible “window of opportunity” during perimenopause.18

Racial and ethnic disparities shape the way different groups experience vasomotor symptoms and genitourinary symptoms of menopause. Research shows that Black individuals are 60% more prone to bothersome vasomotor symptoms than White people, but conversely, they are 50% less likely to begin MHT. Furthermore, Black individuals navigating menopause report vaginal dryness at a higher rate than White individuals. 6

Gender diverse and racialized individuals experience inequities in accessing appropriate menopause care which negatively affect their health outcomes. All individuals who experience perimenopause and menopause deserve quality care.6

Follow-up and monitoring New

Follow-up and monitoring6,7,11,22,27

  • Effective management of menopause involves follow-up and ongoing monitoring to ensure treatment plans are optimized and symptoms are well-controlled.
  • For primary care clinicians inheriting individuals who have already initiated menopausal hormone therapy (MHT) or bioidentical hormone regimens, the focus shifts from initiating therapy to continuing and monitoring it effectively. This includes:
    • Maintaining the therapeutic conversation
    • Reassessing treatment goals
    • Ensuring ongoing safety
  • Follow-up should include:
    • Regular evaluation of symptom control (frequency and severity)
    • Discussion of side effects
    • Risk assessment for CVD and VTE to ensure safety of MHT need and dosing
    • Routine assessment of cardiovascular, breast and bone health
  • For switching between MHT products, begin with the equivalent dose in the new product.
  • In individuals with an intact uterus, when increasing beyond the standard dose of estrogen in MHT, ensure progestogen dose increases appropriately for endometrium protection.
  • There is no recommended duration or stop time for MHT or non-hormonal management of menopausal symptoms. The duration should be individualized, and treatment should continue as long as benefits outweigh risks and symptoms persist. Vaginal estrogen can be continued life-long.
  • For individuals who are stopping MHT, offer the choice of gradually reducing (to limit recurrence of symptoms) or immediately stopping treatment. Gradually reducing or immediately stopping MHT does not make a difference in symptoms in the long term.

References

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    Crandall CJ, Mehta JM, Manson JE. Management of Menopausal Symptoms: A Review. JAMA. 2023 Feb 7;329(5):405–20.

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    National Institute for Health and Care Excellence (NICE). Menopause: identification and management | Guidance | NICE [Internet]. NICE; 2015 [cited 2025 Sept 17]. Available from: https://www.nice.org.uk/guidance/ng23

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    Health Quality Ontario (HQO). Menopause: Quality Standard [Internet]. 2025. Available from: https://www.hqontario.ca/Evidence-to-Improve-Care/Quality-Standards/View-All-Quality-Standards/Menopause

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    Yuksel N, Evaniuk D, Huang L, Malhotra U, Blake J, Wolfman W, et al. Guideline No. 422a: Menopause: Vasomotor Symptoms, Prescription Therapeutic Agents, Complementary and Alternative Medicine, Nutrition, and Lifestyle. J Obstet Gynaecol Can. 2021 Oct 1;43(10):1188-1204.e1.

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    Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW, et al. EXECUTIVE SUMMARY of STRAW+10: Addressing the Unfinished Agenda of Staging Reproductive Aging. Climacteric J Int Menopause Soc. 2012 Feb 16;15(2):105.

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    Perpustakaan Negara Malaysia. Clinical practice guidelines: management of menopause in Malaysia [Internet]. Obstetrical and Gynaecological Society of Malaysia (OGSM); Malaysian Menopause Society (MMS); 2022. Available from: https://www.moh.gov.my/moh/resources/Penerbitan/CPG/Women%20Health/CPG_Management_of_Menopause_2022_e-version-1.pdf

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    Panay N, Anderson R, Bennie A, Cedars M, Davies M, Ee C, et al. Evidence-based guideline: premature ovarian insufficiency†‡. Climacteric J Int Menopause Soc [Internet]. 2024 Dec [cited 2025 Sept 17];27(6). Available from: https://pubmed.ncbi.nlm.nih.gov/39647506/

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    Baber R, Panay N, Fenton A. 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric J Int Menopause Soc [Internet]. 2016 Apr [cited 2025 Sept 18];19(2). Available from: https://pubmed.ncbi.nlm.nih.gov/26872610/

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    Ministry of Health. Diagnostic Codes [Internet]. 2023. Available from: https://files.ontario.ca/moh-diagnostic-codes-en-2023-09-01.pdf

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    The North American Menopause Society. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause N Y N. 2023 Jan 6;30(6):573–90.

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    The North American Menopause Society. Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society. Menopause N Y N. 2021 Jan 9;28(9):973–97.

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    National Institute for Health and Care Excellence (NICE). HRT and the likelihood of some medical conditions: A discussion aid for healthcare professionals and patients [Internet]. 2024. Available from: https://www.nice.org.uk/guidance/ng23/resources/incidence-of-medical-conditions-with-and-without-hrt-a-discussion-aid-pdf-13553199901

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    Kaufman M, Ackerman A, Amin K, Coffey M, Danan E, Faubion S, et al. The AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause. J Urol [Internet]. 2025 Sept [cited 2025 Sept 18];214(3). Available from: https://pubmed.ncbi.nlm.nih.gov/40298120/

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