Sharing the multidisciplinary clinical approach to peri‐ and postmenopausal women: A Delphi consensus among Italian gynecologists, endocrinologists, and cardiologists for an integrated and optimal approach to clinical practice

Author:

Colacurci Nicola1,Filardi Pasquale Perrone2,Chiantera Antonio3,Colao Annamaria4,Pasqualetti Patrizio5ORCID,Lenzi Andrea6

Affiliation:

1. Department of Obstetrics and Gynecology, Italian Society of Gynecology and Obstetrics University of Campania “Luigi Vanvitelli” Naples Italy

2. Department of Advanced Biomedical Sciences, Italian Society of Cardiology Federico II University of Naples Naples Italy

3. Italian Hospital Obstetricians Gynecologists Association Naples Italy

4. Department of Clinical Medicine and Surgery, Endocrinology, Diabetology and Andrology Unit, Italian Society of Endocrinology Federico II University of Naples Naples Italy

5. Department of Public Health and Infectious Disease Sapienza Rome University Rome Italy

6. Department of Experimental Medicine Sapienza Rome University Rome Italy

Abstract

AbstractObjectiveThe critical phase of perimenopausal period is marked by a reduction in estrogen levels, leading to various clinical issues (vasomotor and neurodegenerative symptoms, increased osteoporosis risk and cardiovascular risk). These complex clinical scenarios pose challenges to clinicians in providing the right support for diagnosis and treatment. A group of Italian cardiologists, endocrinologists, and gynecologists conducted a survey among expert colleagues to assess consensus on controversial issues and best practices for screening and treating peri‐ and postmenopausal women.MethodsThe Delphi methodology was used to analyze responses from a qualitative expert panel comprising 25 cardiologists, 25 endocrinologists, and 25 gynecologists, selected nationwide. Two consecutive questionnaires were proposed between February and May 2023. Agreement among experts was assessed following the Delphi method as developed by the RAND Corporation.ResultsThe results of this Delphi Consensus have been shared by the leading scientific societies: Italian Society of Cardiology, Italian Society of Endocrinology, Italian Society of Gynecology and Obstetrics, and Italian Hospital Obstetricians Gynecologists Association.ConclusionsThe experts highlighted comorbidities and hormone deprivation as crucial clinical problems to be evaluated in perimenopausal women, requiring investigation from cardiovascular and endocrinologic perspectives to assess cardiovascular risk, involving the use of BMI, standard blood samples, endocrine‐metabolic tests, and lifestyle assessment, particularly in women with higher cardiovascular and metabolic risks candidates for hormone replacement therapy (HRT). The experts also agreed on the benefits of HRT in improving lipid metabolism and reducing insulin resistance, thereby mitigating the metabolic risks associated with menopause. However, this therapy should be tailored considering individual women's comorbidities and thrombotic risk.

Publisher

Wiley

Reference39 articles.

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