Menopause Care for the PCP

Welcome and Introductions

• Presenter: Rebecca Casper

  • Family medicine doctor outside Charlotte, North Carolina

  • Certified by the Menopause Society

  • Approximately 40% of practice focused on sexual health and menopause care

• Co-presenter: Maya Bass

  • Program Director, Cooper CMSRU Family Medicine Residency Program, Camden, NJ

  • Regional Clinical Leader, Reproductive Health Access Project for Northeast and Mid Atlantic

• Session Importance:

  • High yield hour for clinicians

  • Discussion of menopause affecting over 50% of the population, especially relevant as 40% of women's lifespan occurs post-menopause

Session Overview

• Outline of Topics:

  • Definitions of menopause

  • Evidence-based treatment options

  • Patient-centered care during menopause

• Patients’ Information Sources:

  • Use of social media (TikTok, Facebook) for menopause information

  • Harm reduction model regarding social media’s influence on patient care

Menopause Definitions and Diagnostic Criteria

• Menopause:

  • Defined as 12 months of amenorrhea.

  • Average age of menopause: 51 years (range: 40-58 years).

  • Importance of recognizing the perimenopausal period:

  • Symptoms can begin 4-12 years before menstruation stops.

  • Symptoms may persist for 5-7 years post-menopause.

Symptoms of Menopause

• Common Symptoms Include:

  • Irregular spotting and amenorrhea

  • Vasomotor symptoms (hot flashes, night sweats)

  • Brain fog, increased depression, anxiety

  • Genitourinary syndrome

  • More comprehensive term than vaginal dryness; includes thinning of skin in genital area affecting sexual activity and urination.

  • Hypoactive sexual desire disorder

• Other Symptoms to Consider:

  • Substance use disorders

  • Palpitations

  • Attention deficits and mood changes

Risk Factors for Difficult Menopausal Transition

• Factors contributing to difficult transition include:

  • Smoking, drinking, substance use

  • High BMI (over 30)

  • Pre-existing anxiety and depression

  • Lower socioeconomic status

  • Poor nutritional status

Special Considerations

• Premature Ovarian Insufficiency:

  • Indicator of potential hormonal treatment needs for those under 40 exhibiting symptoms.

  • Requires different treatment approach compared to standard menopause management.

Diagnosis and Laboratory Tests

• Traditional considerations against routine hormone checks during the menopausal diagnosis:

  • Diagnosis often clinical; emphasizing patient history over lab results.

• When to consider lab work:

  • Symptoms outside of standard menopausal expectations (especially under 40).

  • Assessing hormone levels post-initiation of hormone replacement therapy to evaluate therapeutic effectiveness.

  • Differential diagnoses like anemia, liver abnormalities, thyroid issues, and potential PCOS should prompt lab tests.

Hormone Replacement Therapy (HRT) in Menopause

• First line treatment for bothersome menopausal symptoms:

  • Hormone Replacement Therapy has shifted perceptions over time; now considered generally safe if initiated appropriately.

• Key Data on Hormone Therapy:

  • Benefits outweigh risks for:

  • Women under age 60, within 10 years of menopause.

  • Those with primary ovarian insufficiency should remain on treatment until age range of typical menopause (51-55).

• Contraindications for HRT:

  • Unexplained vaginal bleeding, active liver disease, history of thromboembolic disease, specific breast cancers.

Clinical Approach Toward Hormone Replacement

• Hormone therapy is linked to improvements in:

  • Quality of life

  • Management of vasomotor symptoms

  • Cardiovascular health benefits

• Type of Hormones Used:

  • Estrogens: conjugated equine estrogen, micronized options.

  • Progestins for those with a uterus to prevent endometrial hyperplasia.

  • Recognition of different delivery forms: patches, gels, pills based on patient preferences and symptomatology.

Genitourinary Syndrome of Menopause (GSM)

• Broader scope than just vaginal dryness:

  • It's the term covering bladder, urethra, anatomical changes impacting sexual activity.

• First line treatment:

  • Vaginal estrogen treatment (topical) effective with minimal systemic absorption, safe for breast cancer survivors, and overall user-friendly.

• Importance of discussing comfort, sexual activity, and education on bodily changes during menopause.

Other Treatment Options Besides HRT

• Alternative Medications:

  • SSRIs/SNRIs (e.g., Paroxetine) for symptoms of depression/anxiety that overlap with vasomotor symptoms.

  • Gabapentin and Clonidine as secondary options.

• Integration of Non-pharmacological Approaches:

  • Lifestyle changes: exercise, minimizing alcohol, smoking cessation.

  • Discussion of mindfulness and wellness practices; emphasis on patient engagement and comfort in discussing sensitive topics.

Importance of Patient-Centered Care

• Challenges with traditional medical fears (i.e., risks of hormone therapy).

  • Encouragement of clinicians to align care with patients’ needs and risks, leveraging patient input heavily in decision-making processes.

• Continuous education on recent best practices to allow for effective management of menopausal symptoms.

• Encouragement of referrals to specialized menopause care when necessary, keeping open lines of communication with patients.

Resources for Further Study and Management

• Mention of professional resources, including the Menopause Society and HIPPO Education.

• Various studies and systematic reviews to enhance practitioner comfort in dealing with menopausal care and informed treatment options.

Conclusion

• Emphasis on maintaining a patient-centered approach while ensuring safety in administering treatments.

• Encouragement towards ongoing discussions about women's health issues, challenges, and evolving evidence-based practices to improve menopausal care.