Menopause Information for GPs

Menopause marks a significant transition in a woman’s life. As primary healthcare providers, understanding the stages of menopause and its associated symptoms is crucial for effectively supporting women through this natural biological process. This guide aims to equip GPs with essential knowledge to navigate menopause consultations confidently and know when to refer patients to a gynaecologist for specialised care.

It’s a big life change. The body and mind can feel different, as well as feelings and comfort in some situations. Menopause might impact relationships, work life, or the ability to relax. But even though menopause is inevitable, it doesn’t have to be a pain – the team at TOAG is here to help.

Understanding Menopause

Menopause can occur in five stages. The first three define the standard menopausal transition, while the other two are rare cases when menopause can begin unexpectedly.

Menopause | Toowoomba Obstetrics & Gynaecology

Peri-menopause: Marks the start of the menopausal transition, usually in a woman’s 40s but can vary. Hormone levels (especially oestrogen) fluctuate, causing irregular menstrual cycles. Symptoms include hot flashes, night sweats, mood swings, fatigue, and changes in libido. This phase typically lasts about 5-6 years.
Menopause: Officially diagnosed after 12 consecutive months without a period. Occurs on average at around age 51, but varies widely. Oestrogen levels drop, leading to cessation of menstruation and fertility. Symptoms like hot flashes, vaginal dryness, sleep disturbances, and mood changes may persist but often lessen over time.
Post-Menopause: Begins after menopause and continues for the rest of a woman’s life. Oestrogen levels stabilise at a lower level. Most menopausal symptoms gradually diminish, and women remain at risk for health issues like osteoporosis and heart disease.
Surgical Menopause: Occurs when ovaries are surgically removed along with the uterus. Can happen at any age. Symptoms can be more intense compared to natural menopause. Women may experience severe hot flashes, mood swings, vaginal dryness, and increased risk of osteoporosis and heart disease.
Early Menopause: Affecting only 1% of women before the age of 40. Can result from genetics, autoimmune disorders, and medical treatments like chemotherapy or oophorectomy (surgical removal of ovaries). Similar symptoms and health risks as surgical menopause.

How to Conduct a Menopause Consultation

Menopause is typically a sensitive and important issue for women, and as a healthcare provider, it’s important to offer valuable and compassionate support.

What’s important in the initial menopause consult?

A consultation for menopause should be a longer appointment than a standard consultation to allow the patient to be seen, heard, and provided with the right information regarding her situation. Use open-ended questions, such as “So, you think you have symptoms of menopause. What can I help with?” and allow your patient enough time to discuss her symptoms without feeling rushed. Focus on her main concerns. When making a formal diagnosis, it’s important to ask about the patient’s menstrual cycle history and find out when their last period was.

Another thing to consider during this appointment is to treat it as a midlife health check. By intervening early during this stage, there’s a possibility of preventing health issues from arising later in life. This could involve conducting checks on cholesterol levels, heart health, and blood pressure, among other factors.

What menopause symptoms do women not always volunteer?

Women often hesitate to discuss certain symptoms unless prompted, but they are more open to addressing them when broached. These symptoms generally fall into two main categories:

The first is sexual symptoms. Vaginal dryness, a classic symptom, is one such issue that women may not readily bring up. Similarly, many women may not realise that painful intercourse is not a normal expectation, making it necessary to inquire directly about it. Low libido is another concern that can be significant, particularly when combined with vaginal dryness and painful sex.

The second category involves mood symptoms. Menopause often represents a period of vulnerability for experiencing depression and anxiety. It is beneficial to ask women about their overall emotional state, whether they feel they are experiencing more profound feelings of sadness or anxiety. Additionally, in cases where there is concern, it may be relevant to inquire about alcohol intake, as heightened feelings of depression and anxiety can sometimes lead to increased alcohol consumption.

How do you approach menopause management in a woman under 40?

Early menopause presents a unique set of challenges despite sharing similar symptoms with standard menopause. Among these challenges, fertility emerges as a major concern. For women desiring children, early referral to a fertility specialist to explore options is highly important.

Psychological well-being also takes centre stage during this period. The diagnosis of early menopause can be devastating, often necessitating extensive psychological support for women. Due to the multitude of issues involved, consultations with women experiencing early menopause require additional time to ensure attentive listening and adequate support.

Specialist care is essential for women facing premature menopause, as certain conditions may underlie its onset, necessitating specialised testing. It’s recommended that most women undergoing early menopause consider menopausal hormone therapy (MHT) until around age 50 to safeguard bone and heart health. Early menopause has been linked to increased mortality from heart disease, emphasising the importance of MHT in this population.

It's crucial to differentiate MHT in young women from its application in older women and to address women’s concerns accordingly. Existing research suggesting adverse effects of MHT primarily pertains to older women (50 or older), whereas in younger women, MHT is believed to offer long-term health benefits and potentially prolong life. Clarifying these distinctions can help women make informed decisions about their health management during early menopause.

When to Refer a Menopause Patient to a Gynaecologist

Determining when to refer a menopause patient to a gynaecologist is about understanding your expertise and comfort level in managing complex menopause issues. Menopausal symptoms often coincide with intricate medical problems, requiring a nuanced approach to diagnosis and management.

Special consideration is warranted for women experiencing menopause symptoms following cancer treatment, as their medical history adds layers of complexity to their care. Therapy-related issues, such as persistent symptoms or side effects despite trying different treatments, further complicate the management process.

In cases where the complexity of the patient’s condition exceeds your comfort level or expertise, referral to a specialist is advisable. Collaborative discussions with specialists can help formulate comprehensive care plans tailored to the patient’s needs. For patients in rural areas or those requiring specialised care beyond the provider’s scope, Zoom offers a convenient means of consultation and referral.

What to Know Before Initiating MHT

Before commencing MHT, it’s essential to screen for contraindications. This involves inquiring about the patient’s medical history, particularly regarding breast cancer or other hormone-dependent cancers, as well as any history of deep vein thrombosis, cardiovascular disease, or stroke.

Ensuring that the patient has undergone appropriate screenings, such as mammograms and CSTs, and verifying that they are up-to-date is crucial. Additionally, evaluating a patient’s overall health status, including factors like smoking status and obesity, is important. Addressing these factors before initiating MHT can help optimise the safety and effectiveness of treatment.

Available Resources for Clinicians to Assist in Menopause Consults

We have provided links to available online resources for GPs to help with managing patients with menopause.

Jean Hailes Menopause

Jean Hailes Menopause Health Tool

Jean Hailes Menopause Fact Sheets

AMS Diagnosing Menopause Information Sheet

The 2023 Practitioner’s Toolkit for Managing Menopause

Menopause | Toowoomba Obstetrics and Gynaecology

If you have a patient with a complex case of menopause that you do not feel comfortable with managing, you can refer them to Dr Lanziz Homar at TOAG. His gynaecological expertise extends to the management of menopause in both older and younger women experiencing symptoms.

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