Women's health toolkit
This Women’s Health Hub is categorised into sections best representing the needs of women at different stages of their lives.
Top tips for managing menopause in primary care
Adapted from Primary Care Women’s Health Forum top tips, with permission
- The diagnosis of menopause in women aged over 45 is clinical and based on symptoms. It does not usually require confirmation with an Follicle-stimulating hormone (FSH) level.
- Remember that contraception is needed until infertility can be assumed. The use of intra-uterine progestogen offers endometrial protection and contraception. Refer to FSRH CEU Guideline Contraception for women over 40 for further information.
- Consider menopause as a possible cause of amenorrhoea in women under 45 who are not using hormonal contraception once pregnancy is excluded.
- Recommend Hormone Replacement Therapy (HRT) routinely to women who are menopausal aged under 45, even if they are asymptomatic, to reduce the consequences of long-term hypo-oestrogenism such as osteoporosis and cardiovascular disease.
- Provide and signpost women to reliable patient information, for example, menopause matters and manage my menopause, to allow informed and shared decision making between the woman and her healthcare professional.
- Prescribing is not difficult and decision-making guides are available. Refer to Primary Care Women's Health guidance on management and prescribing HRT in primary care.
- HRT is much safer than you think. NICE Clinical Guidance (2015); Diagnosis and Management provides the evidence and reassurance for use.
- Support the woman to initiate HRT and continue with a review after three months. Once stable review annually to reassess the risk/benefits of ongoing HRT use for her. There is no arbitrary limit to length of use.
- The benefits of HRT outweigh the risks for most women who start treatment aged under 60. Women with any cardiovascular or thrombotic risk factors who are eligible for HRT would benefit from a transdermal preparation.
- Low dose vaginal oestrogens are safe to use for as long as required in most women. Some women will require the use of vaginal oestrogen in addition to their systemic HRT to control their genito-urinary problems.