HRT Recommendation Tool

Menopause Stage: Primary Symptoms: Do you have a uterus? Are you a smoker? Is your blood pressure well-controlled? BMI: Any Contraindications (e.g., history of breast cancer, thromboembolism)?

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Menopause

Definition

Menopause is the natural biological process marking the end of a woman's reproductive years, typically defined as occurring 12 months after the last menstrual period. The average age of menopause is around 51 years, but it can vary widely.

Symptoms

Menopause can cause a range of physical and psychological symptoms due to the decline in oestrogen levels. Common symptoms include:

Vasomotor Symptoms: Hot flushes, night sweats.
Genitourinary Symptoms: Vaginal dryness, discomfort during intercourse, urinary urgency.
Psychological Symptoms: Mood swings, irritability, anxiety, depression.
Musculoskeletal Symptoms: Joint pain, muscle aches.
Sleep Disturbances: Insomnia, disturbed sleep patterns.

Aetiology

Menopause is caused by the natural decline in ovarian function, leading to decreased production of oestrogen and progesterone. Factors that can influence the timing and severity of menopause include:

Age: Most women experience menopause between 45-55 years of age.
Genetics: Family history can influence the age of onset.
Surgery: Surgical removal of the ovaries (oophorectomy) leads to immediate menopause.
Medical Treatments: Chemotherapy or radiation therapy can cause premature ovarian failure.

Diagnosis

Menopause is typically diagnosed based on clinical symptoms, particularly the cessation of menstrual periods for 12 consecutive months. In some cases, additional tests may be used:

Follicle-Stimulating Hormone (FSH) Levels: Elevated FSH levels can indicate menopause.
Oestradiol Levels: Low oestradiol levels may support the diagnosis.
Thyroid Function Tests: To rule out thyroid disorders that may mimic menopausal symptoms.

Management

Management of menopause focuses on alleviating symptoms and preventing long-term health risks such as osteoporosis and cardiovascular disease. Options include:

Lifestyle Modifications: Regular exercise, a balanced diet, and maintaining a healthy weight can help manage symptoms and reduce the risk of chronic conditions.
Hormone Replacement Therapy (HRT): HRT is the most effective treatment for vasomotor symptoms and prevention of osteoporosis. It involves the administration of oestrogen alone or in combination with progesterone.
Non-Hormonal Therapies: For women who cannot or choose not to use HRT, non-hormonal options such as SSRIs/SNRIs, clonidine, or gabapentin can help manage symptoms.
Vaginal Oestrogen: For genitourinary symptoms, localised vaginal oestrogen therapy can be effective.
Bone Health: Calcium and vitamin D supplementation, along with weight-bearing exercises, can help prevent osteoporosis. Bisphosphonates or other osteoporosis medications may be prescribed if needed.
Psychological Support: Counselling, cognitive behavioural therapy (CBT), and support groups can help manage mood changes and psychological symptoms.

References

NHS (2024) Menopause. Available at: https://www.nhs.uk/conditions/menopause/ (Accessed: 24 June 2024).
National Institute for Health and Care Excellence (2024) Menopause: Diagnosis and Management. Available at: https://www.nice.org.uk/guidance/ng23 (Accessed: 24 June 2024).
British Menopause Society (2024) A Guide to Managing Menopause. Available at: https://thebms.org.uk/publications/tools-for-clinicians/ (Accessed: 24 June 2024).
Royal College of Obstetricians and Gynaecologists (2024) Menopause and Women’s Health in Midlife. Available at: https://www.rcog.org.uk/en/patients/menopause/ (Accessed: 24 June 2024).