Diagnosis of the menopause…seriously needs to improve

Diagnosis of the menopause…seriously needs to improve and communication…another topic that needs to be addressed.

It takes some women to be correctly diagnosed as being perimenopausal simply just too long. So why is that?

From a medical perspective, it’s a no brainer to consider the menopause as a possible diagnosis when being presented with a woman between her mid 40s or 50s, with multiple physical and  psychological symptoms relating to the menopause and if asked the right questions, more than likely genitourinary ones ( vaginal, sexual & urinary).

The menopause can contribute to many chronic medical conditions, so I appreciate that certain investigations need and should be done, but I have come across so many women who have either been sent away with antidepressants or have been sent on a rambling trail of investigations, when menopause hasn’t even been considered, which are not only time consuming and distressing for them, but are at a huge and unnecessary financial cost to the NHS.

The menopause is a complex topic, affecting women in such individual ways, to be able to provide adequate management throughout this transitional period there needs to be more awareness right across the board.

Ok let’s just get this down in black and white for all lay people to see as well as the medical profession – diagnosis of the menopause should be established on symptoms alone.

I know, I know when you go to the doctors, not only has it taken a monumental amount of effort and organisational planning to actually get yourself to an appointment in the first place, so sometimes you just like to think that your GP is doing something ‘concrete’ like taking a blood test, but seriously, the menopause should be diagnosed on symptoms alone, here are the current recommendations on FSH tests from the experts…

Blood

FSH (follicle stimulating hormone) blood tests should only be offered to women who are potentially prematurely menopausal, so before the age of 40years. They should not be offered to women within the normal menopausal age boundaries as they are just not accurate enough, your hormones are all over the place, fluctuating up and down like yo yos, which is why the BMS clearly advise not doing this, have a read .

However, if you are below the age of 40 years and are experiencing changes to your menstrual cycle then you should be offered FSH tests. These should be correctly done though. Tests should be done 4 – 6 weeks apart ideally taken in the first 4 days of your cycle and you should be offered between 2 and 3 tests.

When diagnosing the menopause a holistic approach is essential.

Pertinent questions should be asked and certain facts taken into account

The obvious …

  • Past medical history
  • Relevant family medical history
  • Menstrual history

The less obvious but equally as important…

  • What impact are your symptoms having on your personal life and at work
  • Lifestyle choices – the importance of looking at your diet, exercise and general lifestyle choices should be explained.

Before decisions are made on how to cope with and potentially treat certain symptoms each woman should have a full understanding of all symptoms that are associated with the menopause, whether physical, psychological or genitourinary (vaginal, urinary, sexual) and all treatment options should be explained in detail :-

  • Lifestyle choices
  • Diet – the benefits of a healthy balanced diet
  • The benefits of incorporating regular exercise into your life
  • Hormonal treatment available, as in hormone replacement therapy
  • Non hormonal medical alternatives
  • Alternative remedies such as herbal remedies
  • Benefits of alternative therapies such as pilates, reflexology…
GPS and practice nurses need to start giving consistent care and advice nationally.

All GP surgeries should be made aware of the ‘Tools for clinicians’ on the BMS website and all women should be made aware of the phenomenally useful factsheets on the Women’s health concern website

All surgeries should try and have one member of staff specialising in women’s health who is signed up to the BMS that way they would be informed about the latest research and recommendations.

Sheep chatting
COMMUNICATION : Another very important message to get across …your GPs & practice nurses are not telepathic !

If you don’t tell them about all the different symptoms you think you are experiencing then it is much harder for them to make that diagnosis. I realise it’s very difficult for GPs and patients alike to cover everything when you’ve only got a 10 min slot … but give it a whirl and take a list with you – always handy to refer to especially as you’re probably a touch forgetful?!

Unfortunately a lot of women still remain completely unaware that what they are experiencing is related to the menopause. They are unprepared mentally and physically for what is happening to them and for what lies ahead. Many women don’t realise until their perimenopausal symptoms are well and truly upon them resulting in unnecessary suffering sometimes for years and for some women they sadly can’t face the fact that they are actually going through this transitional, hormonal stage of their lives and try to ignore it instead of embracing it!

Education about the hormonal changes that occur at this time in our lives needs to be given from an early age instead of women having to find things out for themselves. To me it’s a no brainer to include information about the menopause alongside the education received in senior schools re puberty, sex education … it would then be normalised and just accepted as the next natural stage in a woman’s life, which it is, instead of still not being acknowledged as a serious enough issue to provide education on, so making it this ridiculously taboo topic.

Women would know what to expect and look out for, would understand the need for healthy lifestyle choices, there would be better, more productive communication between patient and practitioner — end result — less women suffering and more women experiencing a better quality of life.

Just a bit of common sense and communication needed! Cut down on GP visits, cut down on unnecessary investigations, better health — less fractures and cardiovascular problems.

I recently read this in one of the medical journals, how true is this …

’The general perception of a menopausal woman needs to change – they should be valued for their wisdom, knowledge and life experience and as such be acknowledged as an invaluable asset to society’


Summary : useful links :-

BMS : https://thebms.org.uk/publications/tools-for-clinicians/

Women’s Health Concern : https://www.womens-health-concern.org/help-and-advice/factsheets/

Nice guidelines re diagnosis : https://www.nice.org.uk/guidance/ng23/chapter/Recommendations#diagnosis-of-perimenopause-and-menopause

Nice guidelines re anti-depressants : https://www.nice.org.uk/guidance/ng23/chapter/Recommendations#managing-short-term-menopausal-symptoms