Global toolkit to diagnose menopause
Created at Monash University, the world’s first toolkit is designed for GPs to use with women from the age of 40. Thought to be the first of its kind, researchers say the toolkit has the potential to help manage menopausal conditions for women globally.
The Practitioner Toolkit for Managing the Menopause, which includes a diagnostic tool, as well as a compendium of approved hormone therapies, is published today in the journal, Climacteric.
Led by Professor Susan Davis, the research team from the School of Public Health and Preventative Medicine, combined existing research on menopause, diagnostic algorithms and extensive clinical experience to develop the diagnostic tool. Designed for use in a GP surgery, it also works through a patient’s medical history and risk factors to arrive at the best treatment solution.
Professor Davis said the toolkit fills the void of clear guidelines on menopause diagnosis and management, equipping doctors with the fundamentals to care for any woman who walks through the door.
“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,” Professor Davis said.
“Based on feedback from patients and doctors we realised there’s widespread confusion, not only in how to determine when menopause starts but also prescribing appropriate treatment to help with side effects.
Diagnosing Menopause
Frequently, the diagnosis of menopause has already been made by the woman herself. She attends her GP with symptoms such as hot flushes or night sweats interrupting her sleep, together with changes in her menstrual cycle. Not all women with menopausal symptoms will need treatment. Most women will be glad of information about menopause and about the safe and effective treatment options available. The questions we should be asking her are “Why did you come to see me”, and “What do you hope to get out of this consultation?”
Common questions are:
How long does menopause last?
When will I be through it?
What are the pros and cons of taking HRT for me?
Can I treat my symptoms naturally?
If I do decide to take HRT, for how long should I take it?
When am I no longer fertile and when should I stop using contraception?
There is a lot of information to give, and even if a menopause information sheet is given, a long appointment will be required to give all the information required and answer questions. Menopausal women often have multiple health issues that need addressing and they may be anxious and tired due to sleep disturbance.
With many recent medical graduates receiving little training in this area, we realised there was a clear need for simple and practical guidelines,” she said.
Menopause, also known as ‘the change of life’, marks the end of the monthly cycle of menstruation and reproductive years in a woman’s life. Most women reach menopause between the ages of 45 and 55.
Professor Susan Davis said due to hormonal changes, menopausal symptoms, which include hot flushes, anxiety and depression and joint pain, vary widely from none at all to debilitating, making a straightforward diagnosis difficult.
“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,” Professor Davis said.
Diagnosing Menopause
The time when most women are trying to understand what is happening to them is during the peri-menopause. During this time of hormonal fluctuation women may experience some, but not all of the symptoms listed in the table. For instance, she may come with severe joint aches and tiredness which may be suggestive of a rheumatological disease. Checking a symptom score will often reveal many more menopausal symptoms than that woman realized she was experiencing.
In most cases, recording a symptom score helps to make the diagnosis and at the same time educates the woman. Checking an FSH level or serum oestradiol and progesterone are totally unnecessary tests in diagnosing menopause, and doing an androgen profile as a routine on all peri-menopausal women is unnecessary and costly. Respond to the symptoms, not the biochemistry!
Many women come to the consultation expecting a blood test to diagnose menopause, and it is important to explain to them why we use the symptom score rather than a blood test in establishing a diagnosis. It is important to explain to women that the blood tests of FSH/Oestradiol can fluctuate on a daily basis and therefore are not useful or necessary. It is especially unhelpful to do hormone blood tests while women are on HRT/OCP - symptoms, not blood levels guide your therapy.
“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,” she said.
The free resource includes a flow chart of standardised questions for doctors to ask, and assess women who are potentially experiencing menopause. The kit also flags safety concerns, provides a list of all hormone therapies approved by regulators in different countries and lists non-hormonal therapies that have evidence to support their use.
Professor Davis said the toolkit would also help inform GPs and patients on the benefits and risks of menopausal treatment.
“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,” said Professor Davis.
The International Menopause Society (IMS) is promoting the use of the toolkit throughout the world, stating that it is the first to present structured practical advice.
IMS President, Rod Baber said the toolkit builds on formal guidelines on menopause.
“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 menopausal hormone therapy options are,” said Rod Baber.
General Practitioner Dr Jane Elliott said the toolkit was clear and accessible, making it ideal to use for GP consultations.
“The flow-chart should be on the computer desk top of all GP’s. This will go a long way towards helping busy GP’s feel that managing menopause is no longer in the ‘too hard basket’ and women will benefit as a result,” Dr Elliot said.
Leading Endocrinologist and President of the Australasian Menopause Society, Dr Anna Fenton welcomed the introduction of the toolkit, recommending widespread use amongst health practitioners.
“In an area fraught with myths and misinformation, this toolkit provides concise and accurate information. The key messages are clear and the advice is practical and evidence-based. 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,” Dr Fenton said.
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The Practitioner Toolkit for the Managing the Menopause will be available to download for free from Climacteric from Monday 7 July.
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Lucy Handford
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Monash University