Introduction to Clinical Practice Guidelines for Menopause 2026

INTRODUCTION As early as 1959, Simpson articulated a prevailing view of menopause as a physiological state requiring treatment only when symptoms interfered with daily functioning.[1] While progressive for its time, this perspective predates contemporary evidence recognizing the menopausal transition as a biological window for preventive and holistic health interventions. In everyday clinical practice, physicians are guided by the principle of “working with what is available, where we are, rather than with what we wish for, to deliver the best possible care to patients.” Guidelines, unlike prescriptive protocols, support clinician judgment and informed decision-making. Do we need country-specific guidelines? Yes. Healthcare delivery models, population characteristics, and contextual realities vary widely across countries and cannot be readily extrapolated from one setting to another. The Clinical Practice Guidelines for Menopause (CPG M), developed under the aegis of the Indian Menopause Society (IMS), provide a comprehensive overview of the complexities of the menopausal transition, timely risk assessment, preventive interventions, and shared decision-making. These guidelines reframe menopause care by providing clear, evidence-based definitions of symptoms and their management and by proposing a structured three-tier healthcare system and a multidisciplinary approach to improve menopausal health outcomes. These guidelines aim to bridge the gap between evidence-based and experience-based practice by integrating robust global scientific literature with published and unpublished Indian data and informed expert consensus, thereby ensuring relevance, feasibility, and scientific rigor in real-world clinical care. The U.S. Food and Drug Administration’s removal of the black box warning in November 2025 marks a pivotal shift in menopause medicine from fear-driven messaging to evidence-based, individualized risk–benefit assessment and informed choice. Nevertheless, the clinician’s role remains one of balance, ensuring that menopausal hormone therapy is offered judiciously, with careful patient selection, counseling, and ongoing review. TARGET AUDIENCE The target audience for the guidelines includes adult women, IMS members, gynecologists, physicians, endocrinologists, oncologists, cardiologists, psychologists, nutritionists, physiotherapists, and policymakers involved in women’s health and midlife care. OBJECTIVES The monogram of this executive summary serves as the core reference for the Credentialed IMS Menopause Practitioner (CIMP) examination held annually To guide health-care practitioners in the systematic clinical assessment, diagnosis, risk stratification, and individualized management of women during the menopause transition and postmenopause To aid primary care physicians in understanding the basics of menopausal health and enable appropriate and timely referral to specialists, as required To inform and support health policy formulation by providing an evidence-based framework for integrating menopausal health into national noncommunicable disease (NCD) strategies, primary healthcare services, and women’s health programs To raise awareness among health professionals and policymakers of the health priorities of the aging woman and to promote the establishment of structured menopause clinics across levels of care To stimulate interest in research across all aspects of menopausal medicine. METHODS The 2026 CPG M builds on earlier IMS guideline documents released in 1998, 2002, 2008, 2010, 2012, and 2020. The methodology underpinning guideline development was detailed in the 2012 editorial and has been updated and expanded for the current edition.[2] Planning and execution of the 2026 guidelines spanned over 1 year. Key clinical questions were structured using the PICOTS framework, specifying the population, intervention, comparator, outcomes, timing, and setting, to inform systematic evidence identification and review.[3] Evidence was sourced through systematic searches of electronic databases, including PubMed, MEDLINE, and the Cochrane Database of Systematic Reviews, as well as from published international and national guidelines, consensus statements, and standard reference textbooks on menopause management. The document also incorporates relevant abstracts from oral and poster presentations at national IMS scientific meetings, along with structured expert opinion where high-quality evidence was limited. The Core Guideline Committee (Chair and Co-Chairs) conducted multiple online meetings to critically appraise evidence and review, refine, and finalize each recommendation. The draft guidelines underwent internal review by the IMS Peer Review Task Force, followed by external review by National and International Review Boards comprising multidisciplinary medical experts, patient advocates, and ethicists. SYSTEM FOR GRADING: EVIDENCE USED IN THE DOCUMENT The quality of evidence and the level of recommendation were done using the Grades of Recommendation, Assessment, Development, and Evaluation system.[3] Recommendations are based on strong evidence and suggestions on experience-based evidence.[4] DISSEMINATION OF THE GUIDELINE To facilitate wide dissemination and accessibility, the Executive Summary and Recommendations of the Guideline are available on the Indian Menopause Society (IMS) website (www.indianmenopausesociety.org) and are published in the Journal of Mid-Life Health. To maximize reach and implementation, the guidelines will be disseminated through IMS-accredited CME programs, national and regional conferences, webinars, and structured training initiatives, including the CIMP examination. Additional dissemination strategies include open-access digital, mobile-friendly resources distributed through IMS platforms; engagement with professional bodies, academic institutions, and policymakers; and the use of simplified patient-facing materials in regional languages through the IMS 35-Plus Committee. BENEFITS OF USING THE GUIDELINES The benefits of using these guidelines are as follows: (i) improved quality of care; (ii) early detection and management of NCDs; (iii) recognition of the urgent need for preventive health programs by all stakeholders related to women’s health; and (iv) given the significant lacunae in Indian data, it is hoped that the guidelines will stimulate interest in research into various aspects of menopause. LIMITATIONS AND RESEARCH GAPS The guideline is undoubtedly limited by the paucity of robust research evidence on pharmacological management in India, but the effort has been directed toward tailoring the recommendations to the diverse Indian context using the best available evidence. Future research priorities identified by the guidelines include longitudinal studies following women through the menopausal transition, qualitative research exploring women’s experiences and preferences, and intervention studies evaluating the effectiveness of various treatment approaches in Indian populations. CONCLUSION The responsibility for developing specialty menopause clinics, modeled on antenatal clinics, in both the private and public sectors, and for advancing menopause management as a medical specialty, lies with the government and nongovernmental organizations. Meanwhile, the guideline aims to provide a resource book to support the busy clinician in delivering optimal care to the aging woman. Equally important, when women are informed and supported, self-care becomes a powerful and enduring contributor to healthy aging. REVISION OF THE GUIDELINE The recommendations are to update the guidelines every 5 years. “Serving as Chair for three consecutive revisions of the Executive Summary and the Monograph of the CPG M has been an enriching and deeply fulfilling journey. It has been a privilege to contribute to the evolution of these guidelines, and I now hand over the responsibility for the next revision with confidence, assured that it is entrusted to the capable and committed hands of my Co-Chairs.” EDITORIAL INDEPENDENCE The views expressed in this guideline are independent of any external influences. Disclosures No conflicts of interest relevant to this document were declared. Artificial intelligence tools were used solely as adjuncts to support drafting, editing, and summarising the manuscript. All clinical interpretations, recommendations, and final decisions were independently reviewed, validated, and approved by the guideline development committee.