The Initial Menopause Consultation
Menopause consultations are becoming more complex because of the various therapies and the controversies regarding hormone replacement therapy (HRT). The following details useful information from the patient and any assessment that may be required.
1. Periods, symptoms and contraception
2. Personal or family medical problems
a] Breast/ ovarian/ bowel cancer in close family members
b] Deep vein thrombosis or pulmonary embolism
c] Risk factors for heart disease and strokes?
d] Risk factors for osteoporosis
3. What does the patient want?
Physical examination should include BMI and BP. In March 2001, The Committee on Safety of Medicines (CSM) advised that clinical examination of the breasts and pelvic examination is not routinely necessary in all women taking HRT, but should be performed if clinically indicated. These recommendations are in line for women taking the oral contraceptive pill.
Women should also be encouraged to participate in the national cervical screening programme (cervical smear testing), which invites women aged 25-64 in England and age 20-60 in Scotland. The national mammography screening programme and breast awareness must be discussed. In the UK all women aged 50-70 years are invited to have a mammogram every 3 years. This screening is also offered to older women but currently there is no automatic invitation. In the UK, the National Institute for Clinical Excellence has produced clinical guidance for the classification and care of women at risk of familial breast cancer in primary, secondary and tertiary care.
The words "clinically indicated" for pelvic examination should relate to past or current disease, symptoms or family history. It is important not to miss a pelvic mass, or a pregnancy.
It is a woman's evidence based patient choice to take or not to take HRT, and her decision must be recorded in the notes.
Whilst great care has been taken to ensure the accuracy of information contained
in the fact sheets, the authors and the BMS cannot accept any responsibility
for any errors omissions, mis-statements or mistakes or for any loss or damage
arising from actions or decisions based on information contained in this publication.
Ultimate responsibility for the treatment of patients and interpretation of
published material lies with the medical practitioner. The opinions expressed
are those of the authors, not necessarily those of the BMS. The inclusion in
the publication of material relating to a particular product, method or technique
does not amount to an endorsement of its value or quality, or of claims made
by its manufacturer.
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