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Most women reach menopause between the ages of 45 and 60, with the average age being 51. Menopause is the permanent cessation of menstrual bleeding caused by loss of ovarian follicular activity, and can be diagnosed clinically in women over the age of 45 who have not had a menstrual period for 12 months. Menopausal symptoms can persist for many years after the point of menopause, and are a common reason for consulting a primary care practitioner.

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The most common symptoms include vasomotor symptoms (hot flushes, sweating at night), cognitive impairment and mood disorders (such as anxiety, mood changes, irritability, sleep disturbance and reduced concentration and memory) and genitourinary symptoms (such as vaginal dryness, dyspareunia and urinary tract infections).

For women suffering from menopausal symptoms, it is essential to discuss the benefits and risks of hormone replacement therapy (HRT). HRT is primarily used to relieve symptoms cause by oestrogen deficiency; however, it also may reduce the risk of cardiovascular disease (CVD), diabetes and osteoporosis. HRT is available in oral and transdermal forms, with a low-dose vaginal oestrogen also available for relieving vulvovaginal symptoms.

Genitourinary syndrome of menopause (GSM) is a term used to describe vulvovaginal symptoms such as vaginal dryness, dyspareunia, vaginal wall prolapse and urinary symptoms such as urinary incontinence, frequent urinary tract infections and dysuria that occur as a result of oestrogen deficiency. It is estimated that more than half of postmenopausal women suffer from some aspect of GSM, however less than half consult with their doctor. Therefore, it is important for the general practitioner to ask about these symptoms, and offer appropriate treatment such as vaginal oestrogen.

Postmenopausal women are at greater risk of certain conditions such as hypertension, CVD, osteoporosis and diabetes and as such, require careful risk assessment and screening for these conditions. The postmenopausal period is an ideal time to perform a formal risk assessment for CVD, which includes measurement of blood pressure and cholesterol levels and addressing any modifiable risk factors such as smoking, hypercholesterolaemia, diet, activity levels and alcohol intake. Several scoring systems are available to estimate an individual’s risk of a cardiovascular event, such as the QRISK assessment tool. For women with a high risk of CVD, lifestyle changes are recommended, and primary prevention with a statin may be appropriate where lifestyle modification is not effective.

Osteoporosis is more common in the postmenopausal woman, due to the declining levels of oestrogen. It is important to perform a risk assessment for all women over the age of 50, and consider performing a DEXA scan in high risk patients to ascertain if osteoporosis is present. Where osteoporosis is diagnosed, treatment with e.g. bisphosphonates is recommended to reduce fracture risk.

Postmenopausal women may be more prone to weight gain and obesity, so it is useful to monitor weight and discuss the importance of a balanced diet and maintenance of exercise. Women may become less active during the postmenopausal period, so it may be useful to talk about less strenuous forms of exercise such as walking and yoga to maintain fitness. Regular exercise has the added benefits of reducing the risk of CVD and osteoporosis.

Finally, it is important to highlight the importance of attending for any scheduled screening appointments such as cervical screening and breast screening, and attending early with any changes to health.

Dr Samantha Miller, MBChB

Read another article like this one: Women’s obesity & weight management in primary care

References

1. National Institute of Clinical Excellent (NICE)(2022). Clinical Knowledge Summary. Menopause. https://cks.nice.org.uk/topics/menopause/
2. Australasian Menopause Society https://www.menopause.org.au/
3. Department of Health, State Government of Victoria, Australia. Better Health Channel: Menopause. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/menopause
4. Australasian Menopause Society. AMS Guide to Equivalent MHT/HRT Doses. https://www.menopause.org.au/images/stories/infosheets/docs/AMS_Guide_to_Equivalent_MHT-HRT_Doses_1020_V1.pdf
5. Department of Health, State Government of Victoria, Australia (2022). Better Health Channel: Weight Management. https://www.betterhealth.vic.gov.au/healthyliving/weight-management
6. Department of Health, State Government of Victoria, Australia (2022). Better Health Channel: Hormone replacement therapy (HRT) and menopause. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/hormone-replacement-therapy-hrt-and-menopause
7. The Royal College of General Practitioners (2022). Osteoporosis prevention, diagnosis and management in postmenopausal women and men over 50 years of age. https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/osteoporosis
8. Australian Government: Department of Health and Aged Care (2022). Overweight and Obesity. https://www.health.gov.au/health-topics/overweight-and-obesity
9. Australian Family Physician (2017). Genitourinary syndrome of menopause. https://www.racgp.org.au/afp/2017/july/genitourinary-syndrome-of-menopause