Primary care physicians now have access to a “toolkit” of decision aids aiming to simplify the process of menopause diagnosis and management for the women who present concerns or symptoms.
The one-page flowchart algorithms were developed by researchers from Monash University in Victoria, Australia, who felt that a “void” needed filling amid the various guidelines on menopause that can run to dozens of pages in length.
The easy-to-use information should make effective menopause management more realistic within the short consultations women have with their primary care physicians.
The team was led by Prof. Susan Davis, of the School of Public Health and Preventative Medicine at Monash. She says: “There are many detailed guidelines available on menopause, but the reality is that most GPs don’t have the time to work through a 40-page report when they only have 5 or 10 minutes with a patient.”
Prof. Davis adds:
“With many recent medical graduates receiving little training in this area, we realised there was a clear need for simple and practical guidelines.”
The decision aids developed by the team are applicable globally after they trawled all the best available evidence and took account of the different therapies used around the world.
Crunching these details down into flowcharts, the team was aiming to remove the “widespread confusion, not only in how to determine when menopause starts but also prescribing appropriate treatment.”
“Half the world’s population will experience menopause as some point in their lives, yet there isn’t a commonly used diagnostic tool, and that’s creating confusion amongst women and doctors,” Prof. Davis says, adding:
“Many people think the menopause is the same for every woman but the reality is quite different. Every woman has her own individual experience of menopause and that sometimes makes it tricky to diagnose.”
The team published their resource in the journal Climacteric, and the authors write: “To our knowledge, this is the first clinical practice tool for the management of the menopause in primary care that has international application.”
The toolkit is available online for free, and the assessment and management algorithms – which can be assembled into a folded desktop reference with brief supporting text – include these flowcharts:
- The woman’s symptoms and concerns
- Menopause staging decision tool – to “accommodate women who may have amenorrhea” for other reasons (for example, they have stopped menstruating because of surgery)
- Assessment – taking a history, doing a physical examination and ordering any tests
- Treatment options (including hormonal and non-hormonal)
- Symptom management – to address an individual woman’s specific problems.
The resource is the result of the team’s “detailed literature reviews and expert opinion, and provide evidence-based clinical practice guidance.”
The toolkit uses standardised questions for doctors to ask women who are potentially experiencing menopause, and includes flags for safety concerns. It lists all hormone therapies approved by regulators in different countries and “non-hormonal therapies that have evidence to support their use.”
The decision aids help to weigh up the risks and benefits of menopausal treatment, Prof. Davis says, adding:
“Hormone therapy is commonly prescribed to women, but its success varies according to symptom type and severity, personal circumstances and medical background.
“This toolkit has the potential to change that because it’s designed to work as just as well for a 41-year-old woman in Madras as it will for the 48-year-old in Manhattan.”
The roll out of the globally applicable guidance is being promoted by the International Menopause Society (IMS).
The IMS says it is “the first to present structured practical advice” and its president, Rod Baber, says the toolkit builds on formal guidelines on menopause. He adds:
“This will ensure that each individual woman is well informed about what happens to her as she ages, about what options for treatment and monitoring are available and, lastly, what the menopausal hormone therapy options are.”
The researchers have also attracted the support of Dr. Anna Fenton, an endocrinologist and president of the Australasian Menopause Society.
Dr. Fenton says menopause is an “area fraught with myths and misinformation,” adding:
“Many women are confused and uncertain about how best to deal with the menopause. Doctors can also face uncertainty in how best to treat and support patients with menopausal symptoms. This toolkit has the potential to change that.”
In other menopause findings, according to researchers publishing in the journal Menopause in January 2014, smoking causes earlier menopause in some white women.
In June 2013, Brisdelle (paroxetine) became the first non-hormonal treatment for hot flashes to be approved by the FDA.