Menopause 'Toolkit' Debuts

Ricki Lewis, PhD

July 10, 2014

A "menopause toolkit" that summarizes everything a clinician needs to know to identify menopause and prescribe treatment was introduced in an article published online July 6 in Climacteric. The International Menopause Society has endorsed the toolkit for global use.

Many organizations have published guidelines and position statements for treating menopause symptoms. However, concise yet comprehensive documents useful at routine consults by primary care physicians and nurse practitioners are lacking.

Fiona Jane, MD, and Susan Davis, MD, both from the Women’s Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, and colleagues used clinical experience, published diagnostic algorithms, position statements, and the peer-reviewed literature to develop the series of flowcharts that comprise the toolkit. It addresses what the researchers term "widespread confusion" among both physicians and patients in determining when menopause starts and whether and how to address symptoms.

The toolkit is available in stand-alone form on the Monash University Web site.

The first flowchart presents symptoms and concerns, and the second classifies patients as premenopausal, perimenopausal, or menopausal. Following that is a "What do you need to know?" guide covering medical history, exams, and investigations.

Other flowcharts assess types and dosages of hormonal and nonhormonal treatments for vasomotor symptoms (antidepressants, clonidine, gabapentin, pregabalin, hypnosis, cognitive behavior therapy, weight loss, and stellate ganglion blockade). Finally, the "menopausal symptoms management" flowchart guides the clinician through all options, matched to patient characteristics.

Mary Rosser, MD, PhD, an obstetrician/gynecologist at Montefiore Medical Center, gives the toolkit a rave review. "I love it because it is really important for people to remember that women constitute 51% of the population, we all go through menopause, and the population is aging. Providers have varying specialties and interests, and it is hard for us to know everything about everything," she told Medscape Medical News.

Dr. Rosser especially likes the age cut-off of 40 years because inklings of menopause can begin 7 to 10 years before periods cease. "You can make women aware of this earlier, rather than later, so they know what to expect. Menopause isn't as hush-hush as when my mom went through it."

The toolkit also accounts for the fact that menopause is a multiyear transition, and the details allow for the many differences among individuals. It delineates the specifics that women muddling through the soaked sheets, foggy thinking, and inexplicable abdominal weight gain recognize. "Patients think they need a psychologist because of the mood swings. They say partners or husbands just dismiss their symptoms. Giving women knowledge and awareness gives them power to understand that this is all normal," Dr. Rosser said.

However, the toolkit may be less useful for specialists in women's health. "The information is worth reading, and I think it may be very helpful for a general practitioner. However, as gynecologists, we do this in our minds routinely," Beatrice Tsao, MD, obstetrician-gynecologist at CareNet Medical Group in Schenectady, New York, told Medscape Medical News.

Dr. Davis is an investigator for Trimel Pharmaceuticals Canada and has received funding from Lawley Pharmaceuticals and Besins Healthcare. Dr. Jane, Dr. Rosser, and Dr. Tsao have disclosed no relevant financial relationships.

Climacteric. Published online July 6, 2014. Full text

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