By vgreene, 17 December, 2014 Consider ospemifene for pts w/o contraindications3 who prefer non-estrogen PO tx
By vgreene, 17 December, 2014 If no breast/endometrial CA or other hormone-sensitive CA: Consider low-dose vaginal estrogen,3 vaginal DHEA, systemic estrogen tx,4 or ospemifene
By vgreene, 17 December, 2014 For menopausal2 women ≥45 yo2 w/ mild GSM sx (genital dryness, burning, or irritation; urinary sx/conditions of dysuria, urgency, or recurrent UTIs; sexual sx of pain/dryness):1
By vgreene, 17 December, 2014 Proactively ask pts about/evaluate on an ongoing basis for GSM sx, regardless of other tx
By vgreene, 17 December, 2014 If SSRI/SNRI contraindicated: Consider gabapentin, pregabalin, clonidine6
By vgreene, 17 December, 2014 If SSRI/SNRI not contraindicated: Consider low-dose paroxetine (7.5 mg/day) or other well-studied SSRI/SNRI (venlafaxine, escitalopram, others).5 If sx control not adequate: Adjust dose/consider gabapentin, pregabalin, clonidine6
By vgreene, 17 December, 2014 Nonhormonal tx for menopausal1 pts ≥45 yo1 w/ mod-to-severe2 vasomotor sx inadequately responsive to behavior mod2 who have HT contraindications3,4 or no interest in HT
By vgreene, 17 December, 2014 If severe/resistant sx, other less well-established tx (eg, stellate ganglion block) may be options