Menopause (An evidence based approach)
Updated: Oct 23
Menstrual periods becoming irregular? Noticing hot flushes, weight gain and changes in your mood? You may be experiencing menopausal symptoms.
Menopause marks a significant transitional phase in a woman’s life and is a fantastic opportunity to book in with your GP to discuss your options and optimise your general health and wellbeing.
Perimenopause is the stage leading up to your last menstrual period and 12months following this. After 12months of no periods, you are considered post-menopausal.
Menopause in most cases occurs naturally between 45-55 years of age with an average age of 51 in Australia. If menopause occurs before the age of 45, it is classified as early or premature menopause and would require specific work up with your GP. This may be due to other factors such as diet, surgery or medications. Menopause may also occur secondary to medical treatment such as surgery, chemotherapy or radiotherapy.
The most common symptoms women go through include hot flushes, night sweats and changes in mood. There may be more
Muscle and joint aches
Brain fog or memory issues
Reduced libido/sexual dysfunction
Vulvovaginal dryness and pain with intercourse
The typical duration of symptoms is approximately 7-10 years and can vary in severity from mild to severe and significantly impact on quality of life. It can be particularly useful to keep a symptom score sheet to monitor the severity of your symptoms over time and I like to refer my patients to the Australian Menopause Society Symptom Score Card.
WHAT TO EXPECT WHEN YOU SEE YOUR GP
Your GP will take a history from you.
- Menstrual history - Assessment of your symptoms - Impact on your wellbeing - Other medical and surgical history - Sexual and contraceptive history - Medications - Family history - Assessing your mental health - Lifestyle factors such as smoking, nutrition, alcohol and physical activity
Your GP will perform a thorough physical examination including your height, weight, BMI and blood pressure. Other examinations if indicated may include assessing your heart health, breasts, thyroid and vulvovaginal health.
In most cases, menopause can be diagnosed without any investigations based on your menstrual pattern and symptoms. In these cases, hormone testing can be unreliable due to unpredictable fluctuations. In some circumstances however, for example if you have an intrauterine device such as a Mirena or in cases or early or premature menopause, we may need to do some blood tests to check your hormone levels. Additional blood and urine tests may be performed to exclude other causes of your symptoms and to assess your general health.
Seeing your GP for a menopause consultation is a good opportunity to engage in preventative care such as ensuring your cervical screening test, mammogram and bowel cancer screening tests are up to date as well as assessing your heart and bone health.
Management of menopause will differ for each individual and should be tailored to suit your wishes, beliefs and personal situation in order to optimise your general health and wellbeing.
Healthy living and lifestyle changes
o Maintaining a healthy weight o Smoking cessation o Adequate dietary calcium and phytoestrogen foods o Regular aerobic, flexibility and strength exercises o Avoiding hot flush triggers such as caffeine, alcohol and spicy foods o Sleep hygiene o Stress management and mindfulness, social connectedness, o Cognitive behavioural therapy with a psychologist o Cooling methods – adjust clothing, use of fans, drinking cool liquids
Non hormonal prescription medications
For women who do not wish to or are unable to take hormone replacement therapy (HRT), other medications including particular antidepressants have been shown to relieve menopausal symptoms such as hot flushes and offer a great alternative to HRT.
Hormonal Replacement Therapy
- Comes in many forms such as patches, tablets, gels - Should not be used in particular cases such as a history of breast cancer or high risk of blood clotting
- Needs a comprehensive discussion of the benefits, risks and side effects of this treatment - When safe to use, is the most effective treatment at reducing menopausal symptoms and fracture rates
Whilst the chance of pregnancy is low, contraception is still recommended for 2 years after your last period if <50years of age and for 1 year if >50years of age. It is best to have a discussion with your GP regarding which contraceptive will be the safest and suit your needs depending on your age and individual circumstances.
Your GP can also help to address any vulvovaginal symptoms you may be experiencing by discussing tips for general vulval hygiene, various lubricants to alleviate vaginal dryness at the time of intercourse or topical estrogen if considered safe. Sexual wellbeing is complex and multifactorial and may require the input of a women’s health physiotherapist, sexual therapist or counsellor.
Menopause symptoms can significantly impact one’s quality of life - physically, emotionally and mentally
Several management options, both non-hormonal and hormonal are available and should be tailored to your individual situation
Seeing your GP for a menopause consultation is a fantastic opportunity for a general health check up and preventative care
Australian Menopause Society https://www.menopause.org.au/
Jean Hailes for Women’s Health https://www.jeanhailes.org.au/health-a-z/menopause
About the author
Dr Ashima runs the Menopause Clinic at Gordon Doctors. She graduated from the renowned University of NSW medical program in 2015 and was admitted Fellow of the RACGP in 2022. Her early career and training were at Ryde, Royal North Shore and Hornsby Hospital in Emergency Medicine, O&G, Mental Health and Neurology, giving her a well versed overview of issues faced by patients in our region. She chosed to specialise in General Practice as this is where she feels that her passion lies, in taking care of patients long term. Previously practising in Kellyville and Cremorne, Dr Ashima now lives locally and is excited to get to know her patients. Her interest areas are Paediatrics, Women's Health, Mental Health, Antenatal Care, Preventative Health, Chronic Disease Management and she is trained in Implanon Insertion and Removal. Dr Ashima enjoys spending time with her young family, cooking and travelling.