Menopause Health Assessment

Streamlined Menopause Health Assessment

Demographics

Married with two children aged 16 and 19. Works full-time as a high school teacher. Non-smoker. Consumes 4–6 standard alcoholic drinks per week, mainly on weekends.

Family History

Mother reached menopause at age 51; no family history of premature menopause. Maternal aunt diagnosed with breast cancer at age 68. Nil family history of ovarian or uterine cancer, or VTE.

Menopausal Status & Symptoms

LMP (Last Menstrual Period): 14/01/2025

Periods: Irregular over the past 18 months, cycle length varying from 24 to 60 days. Flow is moderate for 4 days, minimal dysmenorrhoea, no intermenstrual or post-coital bleeding. Nil current hormonal contraception.

Current Menopausal Status: Peri-menopausal

Modified Greene Climacteric Scale Score: 24

Most Impactful Symptoms (Patient Identified Top 2–3):

• Vasomotor symptoms: Frequent hot flushes and drenching night sweats.
• Sleep disturbance: Severe insomnia secondary to night sweats, causing daytime fatigue.
• Cognitive changes: Brain fog and poor concentration impacting teaching duties.

Hot Flushes/Night Sweats: 6–8 episodes daily and 2–3 drenching sweats nightly, requiring a change of bedsheets.

Mood Changes (Anxiety/Irritability/Low Mood): Increased irritability and mild situational anxiety over the last 6 months; denies depression or anhedonia.

Sleep Disturbances: Wakes 2–3 times per night due to sweats, struggles to return to sleep, resulting in significant daytime exhaustion.

Vaginal Dryness/Dyspareunia: Mild vaginal dryness and occasional superficial dyspareunia.

Brain Fog/Memory: Short-term memory lapses and word-finding difficulties, particularly noticeable during afternoon classes.

Joint Pains: Mild morning stiffness in bilateral hands and knees, resolving within 15 minutes of waking.

Palpitations: Occasional brief awareness of heartbeat during hot flushes, nil associated chest pain or syncope.

Reduced sexual desire: Present over the past year, attributed to fatigue and vaginal discomfort.

Tiredness: Persistent daily fatigue secondary to broken sleep.

Urinary problems: Nil dysuria, frequency, or incontinence.

Irregular Periods: Cycles lengthening up to 60 days over the past 18 months.

Weight Gain: Gained 4 kg centrally over the past year despite unchanged diet.

Overall Impact on QoL

Symptoms are significantly impacting occupational performance and daily functioning. Chronic sleep deprivation and cognitive fog are making lesson delivery and marking difficult, while irritability and low energy are straining family interactions and reducing social engagement.

Brief Medical History & Contraindications

History of Breast Cancer? N

Undiagnosed Vaginal Bleeding? N

History of DVT/PE/Stroke/Heart Attack? N

Active Liver Disease? N

Physical Examination

Blood Pressure: 124/78 mmHg

Height: 165 cm

Weight: 72 kg

BMI: 26.4 kg/m²

General Observation: Well-appearing, NAD.

Investigations & Referrals

Cervical Screening Test (CST): Not Due (Date of Last: 12/08/2022, HPV not detected)

Mammogram: Due (Date of Last: 05/03/2023)

Bone Densitometry (DEXA): Not Indicated

Other Investigations: FBE, ferritin, TSH, fasting lipids, Hba1c, EUC, LFTs ordered to exclude other causes of fatigue and assess baseline cardiovascular risk.

Referrals: BreastScreen Victoria for routine biennial screening mammogram.

Management Plan & Preventative Health Advice

Non-Pharmacological Strategies Agreed

Discussed sleep hygiene measures including maintaining a cool bedroom environment, wearing breathable cotton sleepwear, and avoiding caffeine after midday. Advised reducing alcohol intake to < 2 drinks per week to help mitigate vasomotor triggers and improve sleep quality. Recommended regular weight-bearing exercise 3–4 times weekly and adequate dietary calcium intake (1,000–1,300 mg daily) for bone and metabolic health. Advised regular use of a non-hormonal vaginal moisturiser and water-based lubricant for dyspareunia.

Pharmacological Strategies Agreed

Discussed the risks and benefits of Menopausal Hormone Therapy (MHT) vs non-hormonal options. Explained that combined MHT is the most effective treatment for vasomotor symptoms, sleep disturbance, and bone protection. Discussed baseline risks, noting that transdermal estradiol avoids the increased VTE and stroke risk associated with oral formulations, and micronised progesterone carries a lower breast cancer risk profile compared to synthetic progestins.

Patient Preference

The patient prefers to commence transdermal combined MHT to address her vasomotor and sleep symptoms.

Management Plan Summary

Commence estradiol 50 mcg/24 hr transdermal patch (Estradot®) 1 patch applied twice weekly continuously, and progesterone (Prometrium®) 200 mg PO nocte for 12 days per calendar month (sequential regimen). Provided script and education on application and potential initial side effects (breast tenderness, irregular spotting). Patient to complete fasting bloods this week and book routine mammogram via BreastScreen. Review in 8–12 weeks to assess symptom response, check investigation results, and titrate dose if required.