Key references discussed in the episode:
- NICE CKS. When should I suspect a diagnosis of menopause or perimenopause? March 2022.
- Menopause: diagnosis and management. NG23. 5 December 2019.
- Haskey J. Is the menopause affecting your business? The Menopause Charity.
- Cagnacci A, Venier M. Medicina (Kaunas). 2019;55(9):602. doi: 10.3390/medicina55090602.
- Rossouw JE, et al; Writing Group for the Women’s Health Initiative Investigators. JAMA. 2002;288(3):321-33. doi: 10.1001/jama.288.3.321.
- Collaborative Group on Hormonal Factors in Breast Cancer. Lancet. 2019;394(10204):1159-1168. doi: 10.1016/S0140-6736(19)31709-X.
- Thrombotic risk of contraceptive transdermal patches and the contraceptive vaginal ring. Prescrire Int. 2013;22(143):266, 268-9.
Key take-home points:
- Don’t underestimate the impact of menopause on the patient. It can cause issues physically, emotionally, psychologically and sexually.
- Menopause can be underreported and under diagnosed but is at the forefront of patients’ mind due to increased media coverage.
- Carefully consider the way you counsel patients about HRT because patients have significant worries about side effects and taking medication.
- Use a thorough history and a patient’s symptoms to guide treatment. Practical measures can be helpful along with cognitive–behavioural therapy, but HRT can be an effective and relatively safe option for many patients.
- Our understanding of the risks of HRT has changed but, although the risks are not as high as we once thought, clinical practice in primary care is slow to change.
- HRT can have a positive effect on cardiovascular risk when started earlier, and it has demonstrated an overall improvement in all-cause mortality.
- Transdermal preparations of HRT do not have an increased risk of venous thromboembolism (VTE), but when taken orally, the VTE risk is dose-dependent.