Choosing treatment options for your symptomatic menopausal patients can be challenging.Click “Start” below to utilize the online MQ6 Interactive Treatment Algorithm.Completing this online decision tool will quickly take you through the steps of the MQ6 treatment algorithm to provide recommendations for an individualized management plan based on national and international menopause guidelines.Is Menopausal Hormone Therapy (MHT) indicated?* Is Menopausal Hormone Therapy (MHT) indicated?*Systemic MHT can be safely initiated in women without contraindications who are less than 10 years postmenopause or younger than 60 years of age. There is no specific time frame for duration of systemic MHT and treatment duration should be individualized.Indications for menopausal hormone therapy include:Vasomotor symptoms (day and/or night flashes)(i) In some populations joint pains may be the presenting symptom, although joint pains are not an approved indication for MHTGenitourinary syndrome of menopause(i)GSM: A collection of symptoms and signs associated with reduced estrogen and involving changes to the labia majora/minora, clitoris, vestibule/introitus, vagina, urethra, and bladder. This replaces the older terminology VVA (vulvovaginal atrophy) and urogenital atrophyBone protectionTreatment of Premature Ovarian Insufficiency (FMP < age 40) or early menopause (FMP < age 45)*mandatory fieldYesNoAre local symptoms of GSM the only indication for MHT?* Are local symptoms of GSM the only indication for MHT?*When ONLY treating the local symptoms of the Genitourinary Syndrome of Menopause (GSM), guidelines recommend that local hormone therapy or treatments specific to GSM are preferred over systemic MHT after first line therapies (vaginal moisturizers and/or lubricants) have failed. *mandatory fieldYesNoAre there contraindications to the use of systemic MHT?* Are there contraindications to the use of systemic MHT?*Contraindications to MHT* include:Personal history of Estrogen dependent Cancers (e.g. Breast, Endometrial, Ovarian)Unexplained vaginal bleeding PregnancyCoronary heart diseaseActive or previous history of stroke or VTEAcute liver diseasePersonal history or high risk of thromboembolic disease (e.g. Thrombophilia)PorphyriaWhile migraine with aura is not an absolute contraindication to MHT, primary care providers may consider neurological consultation before prescribing due to possible increased risk of stroke.*consensus opinionAre there contraindications to the use of systemic MHT?*mandatory fieldYesNoDoes the patient have any comorbidities?* Does the patient have any comorbidities?*Relevant comorbidities include: Diabetes mellitus/metabolic syndromeHypertensionHyperlipidemia, High TriglyceridesElevated (moderate) cardiovascular risk(i) Choose a non-hormonal option if high cvs riskElevated risk for VTE (including Factor V Leiden heterozygote/carriers)Smoking(i) Note that smokers also metabolize oral hormones more quicklyObesity(i) Obesity is a risk factor for both CVS disease and VTEMigraineMalabsorptionGallstones(i)Oral hormone therapy increases risk for gallbladder diseaseDoes the patient have any comorbidities?*mandatory fieldYesNoHas the patient had a hysterectomy?* Has the patient had a hysterectomy?**mandatory fieldYesNoHas the patient had a hysterectomy?* Has the patient had a hysterectomy?**mandatory fieldYesNoHas it been more than a year since the final menstrual period (FMP)?* Has it been more than a year since the final menstrual period (FMP)?**mandatory fieldYesNoHas it been more than a year since the final menstrual period (FMP)?* Has it been more than a year since the final menstrual period (FMP)?**mandatory fieldYesNo
