40 CLINICAL
Diagnosing the menopause and HRT
Key learning points
How to diagnose the menopause and the perimenopause What to say to a woman worried about breast cancer risk with HRT Which type of HRT to use for which woman Non-hormonal alternatives to HRT , including herbal medicines
T he menopause is defined as ‘ a biological state in a woman ’ s life when menstruation stops permanently due to the loss of ovarian follicular activity ’. 1 The mainstay of management of menopausal symptoms is hormone replacement therapy ( HRT ), which replaces the hormone oestrogen , but there are other options for women who do not wish to take HRT or who have a medical contraindication to it .
Dr Toni Hazell is a GP in north London
Case study Miss P is a 48-year-old woman whom you are seeing in your role as a nurse practitioner with an interest in women ’ s health . She walks into your room , sits down , takes a deep breath and bursts into tears . She is worried that she might be menopausal . Her last period was six months ago , and she has done several pregnancy tests , which were all negative . She feels very sweaty at night and is having hot flushes during the day . She then goes on to say that she wonders if she is depressed as she is anxious all the time , can ’ t concentrate at work ( which has led to her being performance managed ) and is shouting at her children more than usual . She also feels aches in her muscles and joints and has more headaches than usual . She is tired all the time and is ‘ at the end of my tether ’. You agree – she might be menopausal .
For women aged over 45 , the menopause is a clinical diagnosis . Miss P is going through the perimenopause , which NICE says can be diagnosed based on vasomotor symptoms and irregular periods . When 12 months have passed since the last period , a diagnosis of menopause can be made . 2 For women aged 45 or younger , it is appropriate to confirm the diagnosis with a blood test for follicle-stimulating hormone ( FSH ) – lab ranges vary , but a menopausal level is usually greater than 30 mIU / mL . 3 The FSH level can fluctuate and so a test that is not in the menopausal range does not rule out perimenopause if the woman is symptomatic ; it is therefore a more useful result when in the menopausal range , to confirm your clinical diagnosis in a woman aged 45 or younger .
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1.5 CPD HOURS nursinginpracticelearning . co . uk nursinginpractice . com Autumn 2021