Menopause: The Pause That Refreshes?
EXAM STUDY TIPS
If ever there was a time to remember The Review Course tip that Management = More than Medication it’s the management of menopause. HRT works, works well and is far more safe than most patients believe when used appropriately but it’s generally an uphill battle to slog through all the bad press surrounding the WHI. Furthermore, if you suggest HRT as the only treatment for hot flashes you’re going to miss a lot of points on an exam!
First, tell your patient to Avoid Triggers. Alcohol, hot drinks and warm environments are predictable triggers.
Second, consider Lifestyle Measures. Weight loss, smoking cessation and regular aerobic exercise have all been shown to reduce frequency and intensity of vasomotor symptoms.
Third, consider Behavioural Management. When hot flashes occur it’s helpful to be dressed in layers, to have a fan handy and the ability to open a window.
Fourth, consider Medication. At The Review Course we’ll talk to you about appropriate candidates for HRT. It is the most effective treatment for vasomotor symptoms. Other classes of medication to consider include progestins, the OCP, SSRIs and anticonvulsants.
Finally, consider Complementary and Alternative Medication. In this case you should consider, and not recommend it. There is little evidence that any CAM is more effective than placebo.
PEARLS FOR PRACTICE
I have a specialized practice in women’s health and sexual medicine in the year 2015 and am continually astonished by the following fact: the vast majority of women will not spontaneously mention sexual health concerns to me. I can’t tell you how many times I will specifically ask and then find out that in fact they are very rarely having intercourse because it’s painful and this has started to make their partner quite upset.
Make sure you always ask the question! I find the phrasing “do you have any sexual concerns” to be a good place to start for most patients. You can fix atrophic vaginitis very easily and safely in the vast majority of patients with just a vaginal estrogen. This can be life-changing for patients, but they will rarely bring this up of their own accord even if it’s a huge issue. Sometimes I think it’s embarrassment, but often I get the sense that women just accept this as the natural order of things in menopause. Asking the question gives you the opportunity to be profoundly helpful!
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SOGC Managing Menopause 2014 guidelines