Menopause Consultation Assessment Note

Menopause Health Assessment

Main Concerns

• Worsening hot flushes and night sweats over the past 6 months, significantly disrupting sleep.

• Increased irritability, brain fog, and vaginal dryness causing superficial dyspareunia.

• LMP 14 months ago (age 51); previously regular 28-day cycles with 12 months of oligomenorrhoea prior to cessation; no post-menopausal bleeding.

[x] Vasomotor [x] Psychological [x] Musculoskeletal [x] Genitourinary [x] Sexual [ ] Other

Past Medical History

• G2P2 (2 x NVD); benign endometrial polyp resected in 2019; intact uterus.

• Previous levonorgestrel IUD (Mirena®) removed 3 years ago; partner has had a vasectomy.

• Mild essential hypertension, well-controlled on candesartan 8 mg PO daily.

• Nil history of breast, endometrial, ovarian, or other malignancies.

• Nil personal history of DVT or PE.

• Nil history of fragility fractures or known low bone mineral density.

• History of episodic migraine without aura (1–2 per year).

Family History

• Maternal aunt diagnosed with ER-positive breast cancer at age 68; no known BRCA mutation.

• Nil family history of VTE or thrombophilia.

• Father had an NSTEMI at age 64; hypertension and hyperlipidaemia on paternal side.

• Mother sustained a NOF fracture at age 79; known postmenopausal osteoporosis.

Health Screening History

[x] Breast screening – last mammogram (12/11/2025, NAD) [x] Cervical screening (04/03/2024, HPV not detected) [x] Bowel cancer screening (18/08/2025, iFOBT negative) [ ] Bone density [x] Cardiovascular risk assessment (AusCVDRisk 3% – low risk)

Social History

• Non-smoker (never smoked).
• Balanced Mediterranean-style diet; adequate dietary calcium intake (approx. 3 serves of dairy daily).
• Alcohol: 4–6 standard drinks per week (red wine on weekends).
• Illicit drugs: Nil.
• Complementary therapies: Over-the-counter black cohosh and magnesium glycinate for the past 3 months with minimal benefit.
• Exercise: Brisk walking 30 mins 4x/week and Pilates 1x/week.

Examination

• Height: 165 cm

• Weight: 68 kg

• BMI: 25.0 kg/m²

• BP: 124/78 mmHg

Plan

• Cease black cohosh due to lack of efficacy and potential hepatotoxicity.

• Commence regular non-hormonal vaginal moisturiser (Replens®) 3x/week and use silicone-based lubricant for intercourse.

• Commence transdermal estradiol (Estrogel Pro®) 1.25 g (2 pumps, delivering estradiol 1.5 mg) transdermally daily (transdermal route preferred given history of controlled hypertension and migraine without aura).

• Commence micronised progesterone (Prometrium®) 100 mg PO nocte continuously for endometrial protection.

• Advised on cooling strategies (layered clothing, bedroom fan) and reducing alcohol/caffeine intake to minimise vasomotor triggers.

• Encouraged to increase progressive resistance/weight-bearing exercise to 2–3x/week for bone health, and commence colecalciferol (vitamin D3) 1,000 IU PO daily.

• Review in 3 months to assess symptom resolution, MHT tolerability, and BP, or earlier if any unscheduled vaginal bleeding occurs.