Expert opinion by the Italian Society of Gynecology of the Third Age (SIGiTE) and the Italian Society of Menopause (SIM) on diagnosis and treatment of premature ovarian insufficiency Anna CAPOZZI, , Simona AMBROGGIO, Angelo CAGNACCI, Marco GAMBACCIANI, Stefano LELLO, Costantino DI CARLO Minerva Endocrinology, 2026 Premature ovarian insufficiency (POI) is a critical condition affecting young women before the median age of menopause and consisting of spontaneous oligo-amenorrhea for at least four months associated with follicle stimulating hormone (FSH) levels ≥25 UI/L detected before 40 years of age. Several causes like genetic abnormalities, autoimmune diseases, drugs and/or pelvic surgery may favor this condition that is associated with a deeper clinical impact on women's health compared to physiological menopause. Specifically, cardiovascular and musculoskeletal systems as well as brain could be especially affected by the early loss of ovarian hormones. Therefore, appropriate treatment is necessary to adequately narrow the biological gap with the average age of menopause. Hormone replacement therapy (HRT) is the treatment of choice, regardless of the presence of neurovegetative symptoms. Transdermal high dosage of natural estradiol is generally preferred to guarantee the preservation of cardio-metabolic and bone health. When contraception is required, oral estroprogestins (EPs) maybe considered. A referral to reproductive experts for fertility preservation techniques should be considered case by case.
Hyaluronic acid and erbium laser for the treatment of genitourinary syndrome of menopause Tiziana Fidecicchi, Marco Gambacciani Climacteric, 2025 OBJECTIVE This study aimed to evaluate the effect of the vaginal erbium laser (VEL) in association with vaginal hyaluronic acid (HA) in postmenopausal women suffering from genitourinary syndrome of menopause (GSM). METHODS One hundred sexually active postmenopausal women were selected and divided into three groups using a block randomization method; 10 women declined to participate. The remaining women received three laser applications at 30-day intervals; 22 women dropped out for personal reasons or protocol violations. Group 1 (n = 25) received VEL treatment (XS Fotona Smooth®; Fotona, Slovenia) alone; Group 2 (n = 22) received daily vaginal HA tablets for 10 days after VEL treatment, followed by a twice a week administration during the follow-up period; and Group 3 (n = 21) received daily HA tablets for 10 days before the first VEL treatment and for 10 days after each laser application, followed by a twice a week administration for the follow-up period. Vaginal dryness and dyspareunia were assessed at the screening visit, before VEL treatment, after 1 and 3 months from the last laser treatment, using the visual analog scale. Data were analyzed using one-way analysis of variance and a linear mixed model for repeated measures. The post-hoc test for the interaction between time and treatment was performed using Bonferroni correction. RESULTS A significant (p < 0.001) improvement in both vaginal dryness and superficial dyspareunia was evident, with greater (p < 0.001) improvement in Group 2 and Group 3. CONCLUSIONS The results suggest that vaginal HA administration can improve the VEL effects on GSM in postmenopausal women.
Indications for the use of menopausal hormone therapy after cancer: on what data should we rely on? Angelo Cagnacci, Marco Gambacciani, Stefano Lello, Anna M. Paoletti Gynecological Endocrinology, 2025 Menopause hormone therapy (MHT) is an effective option to treat menopausal symptoms, to prevent osteoporosis, to manage induced or spontaneous premature menopause, and to prevent cardiovascular and...
Systemic hormone therapy after breast and gynecological cancers: an Italian expert group consensus opinion Angelo Cagnacci, Paola Villa, Giuseppina Paola Grassi, Nicoletta Biglia, Marco Gambacciani, Costantino Di Carlo, Francesca Nocera, Salvatore Caruso, Angelamaria Becorpi, Stefano Lello, Anna Maria Paoletti, and Climacteric, 2025 The specific Italian Group of Study of the Menopause formulated a consensus opinion on the use of estrogen therapy (ET) or combined estro-progestin hormone therapy (HT) after breast and gynecological cancers. This consensus is based on the risk of recurrence of the specific cancer during ET/HT, the presence of steroid receptors in cancer cells, the use of adjuvant hormone therapies and data on the use of ET/HT after cancer. The following positions were reached. ET/HT can be used after vulvar cancers and melanoma, but with great caution after the rare adenocarcinomas. ET/HT can be used after cervical cancer, but ET should be used with caution after adenocarcinomas. ET/HT can be used after International Federation of Obstetrics and Gynecology (FIGO) stage I-II estrogen-dependent endometrial cancers, except in Black women, and can probably be used after estrogen-independent endometrial cancers. ET/HT cannot be administered or should be used with great caution after most uterine sarcomas. ET/HT can probably be used after ovarian neoplasms except for granulosa cell tumors, and with great caution after low-grade serous ovarian carcinoma and serous borderline ovarian tumors. ET/HT can be used with great caution in women after estrogen receptor (ER)/progesterone receptor (PR)-positive breast cancer and is probably allowed after ER/PR-negative breast cancer.
Oestrogens in oral contraception: considerations for tailoring prescription to women’s needs Franca Fruzzetti, Tiziana Fidecicchi, Marco Gambacciani European Journal of Contraception and Reproductive Health Care, 2024 BACKGROUND The oestrogenic component of combined oral contraceptives (COCs) has changed over years with the aim of reducing oestrogen-related side effects and risks, whilst maintaining oestrogen beneficial effects, particularly on cycle control. PURPOSE To describe the pharmacological profiles of different oestrogens commonly used in COCs to provide insights on contraceptive prescription tailored to women's needs. RESULTS All COCs ensure a high contraceptive efficacy. COCs containing the natural oestrogens oestradiol (E2), oestradiol valerate (E2V) and estetrol (E4) have limited impact on liver metabolism, lipid and carbohydrate metabolism, haemostasis and sex hormone binding globulin levels, compared with ethinylestradiol (EE). COCs with E2 and E2V appear also to entail a lower elevation of the risk of venous thromboembolism vs. EE-containing pills. No epidemiological data are available for E4-COC. E2- and E2V-containing COCs seem to exert a less stabilising oestrogenic effect on the endometrium compared with EE-COCs. The E4-COC results in a predictable bleeding pattern with a high rate of scheduled bleeding and minimal unscheduled bleeding per cycle. Based on in vitro and in vivo animal data, E4 seems to be associated with a lower effect on cell breast proliferation. CONCLUSION Today various COCs contain different oestrogens. Prescribers must be familiar with the different properties of each oestrogen for a tailored contraceptive recommendation, considering their safety and contraceptive efficacy, as well as women's needs and preferences.
POESIT recommendations on management of body-identical hormones in menopausal symptoms Santiago Palacios, Cláudio Rebelo, Ana Casquilho, Ana Rosa Costa, Angelo Cagnacci, Antonio Cano, Camil Castelo-Branco, Costantino Di Carlo, Fátima Romão, Fernanda Geraldes, Marco Gambacciani, Maria Fasero, Pluvio Coronado, Maria João Carvalho, Rossella E. Nappi Climacteric, 2024 Many women seek treatment to improve menopausal vasomotor symptoms (VMS). The selection of women most likely to benefit from menopause hormone therapy (MHT) is crucial in clinical practice. There is general agreement that women younger than 60 years or who initiate MHT within the first 10 years of menopause, with no contraindications, have greater benefits considering symptomatic relief and additional advantages. This group may have the advantage of protection from osteoporosis and from other chronic diseases that affect postmenopausal women, namely cardiovascular disease (CVD). Cumulating evidence supports MHT for symptomatic women. However, inadequate use according to the needs of symptomatic women led to a burden of suffering worldwide. In recent years, the emergent use of non-regulated body-identical hormones (non-rBHT) can expose patients to potential harms. These hormone preparations are not regulated through the same tests of safety, efficacy or dosing consistency as regulated-BHT (r-BHT). The POESIT (Portugal + Spain + Italy) recommendations highlight the use of 17β-estradiol (E2) and micronized progesterone (P4) as the real r-BHT. In addition, the group emphasizes as an example the data from the REPLENISH study with 1 mg E2/100 mg P4. The combination of the two hormones in one convenient pill showed a clear reduction or elimination of hot flashes and an improvement in sleep quality and, consequently, quality of life. At the same time, this combination has shown high rates of amenorrhea and no significant impact on lipid, glucose or coagulation parameters. Both the REPLENISH study and a real-life retrospective study pointed to the possibility of a lower risk of venous thromboembolism (VTE) with this formulation than with other combinations.
EMAS position statement: Vitamin D and menopausal health Panagiotis Anagnostis, Sarantis Livadas, Dimitrios G. Goulis, Silvia Bretz, Iuliana Ceausu, Fatih Durmusoglu, Risto Erkkola, Ivan Fistonic, Marco Gambacciani, Marije Geukes, Haitham Hamoda, Caoimhe Hartley, Angelica Lindén Hirschberg, Blazej Meczekalski, Nicolas Mendoza, Alfred Mueck, Antonina Smetnik, Petra Stute, Mick van Trotsenburg, Margaret Rees, Irene Lambrinoudaki Maturitas, 2023
Menopause, wellbeing and health: A care pathway from the European Menopause and Andropause Society Irene Lambrinoudaki, Eleni Armeni, Dimitrios Goulis, Silvia Bretz, Iuliana Ceausu, Fatih Durmusoglu, Risto Erkkola, Ivan Fistonic, Marco Gambacciani, Marije Geukes, Haitham Hamoda, Caiomhe Hartley, Angelica Lindén Hirschberg, Blazej Meczekalski, Nicolas Mendoza, Alfred Mueck, Antonina Smetnik, Petra Stute, Mick van Trotsenburg, Margaret Rees Maturitas, 2022
The essential menopause curriculum for healthcare professionals: A European Menopause and Andropause Society (EMAS) position statement Margaret Rees, Kathy Abernethy, Gloria Bachmann, Silvia Bretz, Iuliana Ceausu, Fatih Durmusoglu, Risto Erkkola, Ivan Fistonic, Marco Gambacciani, Marije Geukes, Dimitrios G. Goulis, Amanda Griffiths, Haitham Hamoda, Claire Hardy, Caiomhe Hartley, Angelica Lindén Hirschberg, Angela Kydd, Skye Marshall, Blazej Meczekalski, Nicolas Mendoza, Alfred Mueck, Emma Persand, Kathleen Riach, Antonina Smetnik, Petra Stute, Mick van Trotsenburg, Nese Yuksel, Rachel Weiss, Irene Lambrinoudaki Maturitas, 2022
What women think about menopause: An Italian survey Concetta Maria Vaccaro, Anna Capozzi, Giuseppe Ettore, Roberto Bernorio, Angelo Cagnacci, Marco Gambacciani, Vittoria Coletta, Silvia Maffei, Rossella Elena Nappi, Giovanni Scambia, Elsa Viora, Stefano Lello Maturitas, 2021
Reflections and recommendations on the COVID-19 pandemic: Should hormone therapy be discontinued? A. Cagnacci, G. Bonaccorsi, M. Gambacciani, V. De Leo, C. Di Carlo, G. Bifulco, S. Alfieri, N. Biglia, S. Caruso, E. Cicinelli, P. De Franciscis, A. Gambera, A. Grasso, F. Murina, A.M. Paoletti, F. Vicariotto, P. Villa, A. Volpe, V. De Leo, C. Di Carlo, G. Bifulco, S. Alfieri, N. Biglia, S. Caruso, E. Cicinelli, P. De Franciscis, A. Gambera, A. Grasso, F. Murina, A.M. Paoletti, F. Vicariotto, P. Villa, A. Volpe Maturitas, 2020
Genitourinary syndrome of menopause (GSM) and laser VEL: A review David Elia, Marco Gambacciani, Nicolas Berreni, Jean Marc Bohbot, René Druckmann, Hugues Geoffrion, François Haab, Niko Heiss, Nicolas Rygaloff, Eleonora Russo Hormone Molecular Biology and Clinical Investigation, 2020
Recommendations on menopausal hormone replacement therapy Angelo Cagnacci, on behalf of the Executive Committee of the Italian Society of Menopause (SIM), of the Italian Society of Gynecology of the Third Age (SIGiTE), Marco Gambacciani, Mario Gallo, Stefano Lello Minerva Ginecologica, 2019
Nutraceuticals and functional foods for the control of plasma cholesterol levels. An intersociety position paper Andrea Poli, Carlo M. Barbagallo, Arrigo F.G. Cicero, Alberto Corsini, Enzo Manzato, Bruno Trimarco, Franco Bernini, Francesco Visioli, Alfio Bianchi, Giuseppe Canzone, Claudio Crescini, Saula de Kreutzenberg, Nicola Ferrara, Marco Gambacciani, Andrea Ghiselli, Carla Lubrano, Giuseppe Marelli, Walter Marrocco, Vincenzo Montemurro, Damiano Parretti, Roberto Pedretti, Francesco Perticone, Roberto Stella, Franca Marangoni Pharmacological Research, 2018
Menopause and hormone replacement therapy: The 2017 recommendations of the Italian menopause society Marco Gambacciani, on behalf of the Italian Menopause Society (SIM), Nicoletta Biglia, Angelo Cagnacci, Salvatore Caruso, Ettore Cicinelli, Vincenzo De Leo, Costantino Di Carlo, Manuela Farris, Alessandro Gambera, Secondo Guaschino, Antonio Lanzone, Anna M. Paoletti, Novella Russo, Franco Vicariotto, Paola Villa, Annibale Volpe Minerva Ginecologica, 2018
Hormone replacement therapy: who should be treated? Minerva Ginecologica, 2015
Short-term effect of vaginal erbium laser on the genitourinary syndrome of menopause Minerva Ginecologica, 2015
Vaginal erbium laser: The second generation thermotherapy for the genitourinary syndrome of menopause (GSM) in breast cancer survivors. a preliminary report of a pilot study Italian Journal of Gynaecology and Obstetrics, 2015
EMAS position statement: Vitamin D and postmenopausal health Faustino R. Pérez-López, Marc Brincat, C. Tamer Erel, Florence Tremollieres, Marco Gambacciani, Irene Lambrinoudaki, Mette H. Moen, Karin Schenck-Gustafsson, Svetlana Vujovic, Serge Rozenberg, Margaret Rees Maturitas, 2012
EMAS position statement: Bone densitometry screening for osteoporosis Mark Brincat, Jean Calleja-Agius, C. Tamer Erel, Marco Gambacciani, Irene Lambrinoudaki, Mette H. Moen, Karin Schenck-Gustafsson, Florence Tremollieres, Svetlana Vujovic, Margaret Rees, Serge Rozenberg Maturitas, 2011
EMAS position statement: Managing obese postmenopausal women Irene Lambrinoudaki, Marc Brincat, C. Tamer Erel, Marco Gambacciani, Mette H. Moen, Karin Schenck-Gustafsson, Florence Tremollieres, Svetlana Vujovic, Margaret Rees, Serge Rozenberg Maturitas, 2010
Postmenopausal hormone therapy: An endocrine society scientific statement Richard J. Santen, D. Craig Allred, Stacy P. Ardoin, David F. Archer, Norman Boyd, Glenn D. Braunstein, Henry G. Burger, Graham A. Colditz, Susan R. Davis, Marco Gambacciani, Barbara A. Gower, Victor W. Henderson, Wael N. Jarjour, Richard H. Karas, Michael Kleerekoper, Roger A. Lobo, JoAnn E. Manson, Jo Marsden, Kathryn A. Martin, Lisa Martin, JoAnn V. Pinkerton, David R. Rubinow, Helena Teede, Diane M. Thiboutot, Wulf H. Utian Journal of Clinical Endocrinology and Metabolism, 2010
Position of the International Menopause Society (IMS). Current recommendations on hormonal therapy in postmenopause. February 27, 2007 Revista Iberoamericana De Revisiones En Menopausia, 2007
Menopause and related problems Minerva Medica, 2007
Menopause and hormone replacement therapy: National conference of the Villa Tuscolana (Frascati, Rome, May 8-9, 2007) Giornale Italiano Di Ostetricia E Ginecologia, 2007
Recommendations for hormonal therapy in postmenopausal Giornale Italiano Di Ostetricia E Ginecologia, 2007
Management of cardiovascular risk in the peri-menopausal woman--a consensus statement of European cardiologists and gynaecologists Kardiologia Polska, 2007
Assessment of the QoL in Italian menopausal women: Comparison between HRT users and non-users A.R Genazzani, A Nicolucci, C Campagnoli, P Crosignani, C Nappi, G.B Serra, E Bottiglioni, A Cianci, D De Aloysio, C Donati Sarti, M Gambacciani, P Monteleone, A.D Genazzani, S Guaschino, G Palumbo, F Petraglia, S Schonauer, A Volpe, T Di Paolantonio, M Nagni, A Tempesta, G.A Coronel Maturitas, 2002
The effect of menopause on blood lipid and lipoprotein levels Domenico de Aloysio, Marco Gambacciani, Michele Meschia, Francesco Pansini, Alberto Bacchi Modena, Pier Francesco Bolis, Marco Massobrio, Giuseppe Maiocchi, Elena Peruzzi Atherosclerosis, 1999
Hormone replacement therapy in perimenopause: Effect of a low dose oral contraceptive preparation on bone quantitative ultrasound characteristics Menopause, 1999
Erratum: Body weight, body fat distribution, and hormonal replacement therapy in early postmenopausal women (Journal of Clinical Endocrinology and Metabolism (1997) 82 (414-417)) Journal of Clinical Endocrinology and Metabolism, 1997
Longitudinal evaluation of perimenopausal vertebral bone loss: Effects of a low-dose oral contraceptive preparation on bone mineral density and metabolism Obstetrics and Gynecology, 1994
Bone loss in perimenopausal women: A longitudinal study Mareo Gambacciani, Adriana Spinetti, Fabio Taponeeo, Barbara Cappagli, Silvia Maffei, Pietro Munetti, Laura Piaggesi, Piero Fioretti Obstetrical and Gynecological Survey, 1994
Lack of any estrogenic effect of ipriflavone in postmenopausal women Gian Benedetto Melis, A. M. Paoletti, A. Cagnacci, L. Bufalino, A. Spinetti, M. Gambacciani, P. Fioretti Journal of Endocrinological Investigation Official Journal of the Italian Society of Endocrinology, 1992
Body temperature and pituitary hormone secretion: Central and peripheral indicators of neuroendocrine function New Trends in Gynaecology and Obstetrics, 1991
Prevention of postmenopausal bone loss. A two year prospective study with transdermal 17-β-estradiol administration New Trends in Gynaecology and Obstetrics, 1991
The problem of treatment of oligomenorrhea in adolescence Reproductive Medicine Medical Therapy Proceedings of the Second International Symposium on Reproductive Medicine Ics875, 1989
Prevention of puerperal lactation by a single oral administration of the new prolactin-inhibiting drug, cabergoline Obstetrics and Gynecology, 1988
Effects of the dopamine antagonist veralipride on hot flushes and luteinizing hormone secretion in postmenopausal women Obstetrics and Gynecology, 1988
