Competency in menopause management: whither goest the internist?

Area of Science:

• Internal Medicine
• Women's Health
• Endocrinology

Background:

• Menopausal hormone therapy (HT) use declined significantly after 2002.
• Internists' role in menopause management has diminished.
• Recent research has expanded understanding of HT's effects and mechanisms.

Purpose of the Study:

• To evaluate the current role of internists in menopause management.
• To advocate for internists to resume a central role in menopause care.
• To identify necessary steps for internists to effectively manage menopause.

Main Methods:

• Review of existing scientific literature on menopause and hormone therapy.

Main Results:

• Consensus indicates HT benefits outweigh risks for symptom relief in select menopausal women.
• Non-hormonal agents, SERMs, and tibolone are alternative management options.
• Menopause management decisions are complex, involving multiple systems and disease risks, highlighting the need for internist expertise.
• Most internists lack current expertise in menopause management, leading to fragmented care.

Conclusions:

• Internists' comprehensive approach is ideal for complex menopause management.
• New educational programs are needed for medical students, residents, and practicing physicians to build core competencies in menopause care.