From Established Care to Precision Menopause Medicine: A Clinical-Actionability Framework for Contemporary Menopause Management
4 affiliations
- 12nd Department of Obstetrics and Gynecology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- 2Faculty of Food Science and Technology, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania
- 3Department of Pharmacognosy, Faculty of Pharmacy, Victor Babeș University of Medicine and Pharmacy Timișoara, Eftimie Murgu Square, No. 2, 300041 Timișoara, Romania
- 4Faculty of Pharmacy, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
Abstract
Menopause care now spans established hormone therapy, mechanism-based non-hormonal drugs, behavioural interventions, and emerging microbiome- and biomarker-guided approaches. This state-of-the-art narrative review evaluated which dimensions of personalisation are clinically actionable and which remain hypotheses of precision medicine. A structured PubMed/MEDLINE search (January 2020–July 2026), updated to August 2026 and supplemented by landmark studies, current guidelines, and regulatory sources, was synthesized using a four-tier clinical-actionability framework (A, established; B, evidence-supported off-label; C, emerging; D, experimental). Menopausal hormone therapy remains the most effective treatment for vasomotor symptoms and prevents bone loss during use; the 2025–2026 FDA labelling revisions altered risk communication rather than the underlying evidence, and professional responses diverged. Fezolinetant and elinzanetant provide mechanism-based non-hormonal options, while SSRIs/SNRIs, gabapentin, cognitive behavioural therapy (CBT), CBT for insomnia, and clinical hypnosis remain evidence-supported. Exercise, yoga, acupuncture, soy, and equol are not guideline-recommended for reducing vasomotor symptom frequency despite benefits in other domains. Gut and genitourinary microbiome findings should not be conflated: pooled evidence identifies no consistent postmenopausal gut signature, whereas vaginal Lactobacillus depletion is more reproducible but does not reliably predict symptom resolution. Evidence-based personalisation therefore remains principally clinical; microbiome sequencing, equol testing, and multi-omic treatment selection require prospective test-guided validation.
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BibTeX
@article{iuhas2026from,
title = {{From Established Care to Precision Menopause Medicine: A Clinical-Actionability Framework for Contemporary Menopause Management}},
author = {Cristian Ioan Iuhas and Mădălina-Manuela Marinescu and Corina Danciu and Cristina Mihaela Ormindean and Răzvan Ciortea and Andrei Malutan and Dan Mihu and Zorița Diaconeasa and Liora Colobatiu},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218674},
url = {https://www.mdpi.com/2077-0383/15/21/8674},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - From Established Care to Precision Menopause Medicine: A Clinical-Actionability Framework for Contemporary Menopause Management
AU - Cristian Ioan Iuhas
AU - Mădălina-Manuela Marinescu
AU - Corina Danciu
AU - Cristina Mihaela Ormindean
AU - Răzvan Ciortea
AU - Andrei Malutan
AU - Dan Mihu
AU - Zorița Diaconeasa
AU - Liora Colobatiu
PY - 2026
DA - 2026/11/06
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218674
UR - https://www.mdpi.com/2077-0383/15/21/8674
AB - Menopause care now spans established hormone therapy, mechanism-based non-hormonal drugs, behavioural interventions, and emerging microbiome- and biomarker-guided approaches. This state-of-the-art narrative review evaluated which dimensions of personalisation are clinically actionable and which remain hypotheses of precision medicine. A structured PubMed/MEDLINE search (January 2020–July 2026), updated to August 2026 and supplemented by landmark studies, current guidelines, and regulatory sources, was synthesized using a four-tier clinical-actionability framework (A, established; B, evidence-supported off-label; C, emerging; D, experimental). Menopausal hormone therapy remains the most effective treatment for vasomotor symptoms and prevents bone loss during use; the 2025–2026 FDA labelling revisions altered risk communication rather than the underlying evidence, and professional responses diverged. Fezolinetant and elinzanetant provide mechanism-based non-hormonal options, while SSRIs/SNRIs, gabapentin, cognitive behavioural therapy (CBT), CBT for insomnia, and clinical hypnosis remain evidence-supported. Exercise, yoga, acupuncture, soy, and equol are not guideline-recommended for reducing vasomotor symptom frequency despite benefits in other domains. Gut and genitourinary microbiome findings should not be conflated: pooled evidence identifies no consistent postmenopausal gut signature, whereas vaginal Lactobacillus depletion is more reproducible but does not reliably predict symptom resolution. Evidence-based personalisation therefore remains principally clinical; microbiome sequencing, equol testing, and multi-omic treatment selection require prospective test-guided validation.
SN - 2077-0383
ER -