Personalized care involves tailoring assessments, discussions, investigations, and treatments to the individual’s changing symptoms, preferences, and circumstances, following NICE’s guidelines on patient experience and shared decision-making. Effective communication includes explaining menopause as a natural life transition that can occur in mid-life or earlier due to medical or surgical factors, and involves discussing associated symptoms such as hot flushes, vaginal dryness, mood changes, musculoskeletal pain, and sexual difficulties. Information should be shared with patients and their families about symptom variability and support strategies, including contraception, bone health, physical activity, and fertility options, especially before and after medical or surgical interventions.
Diagnosis of menopause in women aged 45 or over is primarily clinical, based on symptom history and menstrual patterns, without relying on laboratory tests such as FSH or hormone assays, except in specific cases like early menopause or uncertain diagnosis. Ethnic and individual factors influencing menopause onset should be considered. For those under 40, premature ovarian insufficiency diagnosis involves clinical history and elevated FSH levels on two tests, with specialist referral if diagnosis remains uncertain.
Management options include hormone replacement therapy (HRT), cognitive-behavioral therapy (CBT), and complementary therapies. HRT, suited for women with a uterus or hysterectomy, must be discussed thoroughly regarding benefits, risks, type, dose, and duration, with adjustments based on age, health status, and personal risk factors. Non-hormonal options like vaginal moisturizers or lubricants are recommended for genitourinary symptoms, with vaginal oestrogen preferred unless contraindicated. In women with breast cancer history, non-hormonal treatments are first-line, and vaginal oestrogen may be considered cautiously.
For vasomotor symptoms, HRT is first-line, with alternatives like menopause-specific CBT or fezolinetant for unsuitable cases. Treatment reviews are recommended at three months and annually, with adjustments or specialist referrals if symptoms persist or adverse effects occur. The guidelines also address HRT initiation and cessation, emphasizing low doses, informed choices, and careful management in women with cardiovascular, thromboembolic, or cancer risks. Overall, the approach prioritizes personalized, holistic care, balancing benefits and risks through shared decision-making.
Reference:
NICE Menopause: Identification and Management Guideline Summary – Guideline Central. (n.d.). https://www.guidelinecentral.com/guideline/4543751/#section-4683835
