By – Dr. Rhythm Bhalla, Senior Consultant, Obstetrics & Gynaecology, Cocoon Hospital Chandigarh
The menopause discussion is not only about whether a woman has stopped menstruating or not. Sleep, mood, sexual well-being, contraception, and overall well-being should be taken into consideration. Keeping a brief set of questions, the history of menstrual changes and a list of drugs currently being used by a woman can provide her with a better individual plan.
1. Could these changes be perimenopause, or something else?Discuss any changes that have occurred with periods, sleep, mood and physical comfort. Menopause can be confirmed after a year of not having periods, assuming nothing else has been ruled out. Changes can start years before menopause. Determine if medical problems such as an overactive thyroid gland or anemia should be considered.
2. Which treatment options suit my symptoms and medical history?Inquire into hormonal and non-hormonal treatments, including menopausal CBT if available. Hormone treatment might be helpful for some problems, although it is based on individual considerations. Inform your physician about breast cancer, thrombosis, liver disease or unusual bleeding, if you have them.
3. What can help vaginal dryness, urinary symptoms or painful sex?These are very common reasons for seeking medical help, and should not be ignored. Enquire about the use of lubrication, vaginal moisturizers, local estrogen treatment when required, and any infections or other causes. The management should be targeted at the symptoms; not all will require systemic drug therapy.
4. Do I still need contraception?A woman can become pregnant even when she enters the perimenopause stage. Menopausal hormone therapy is not a contraceptive. Find out what kind of contraception would suit you and when you can stop using it. This will depend on your age and type of contraceptive.
5. How should I protect my bones and overall health?Talk about resistance exercises and weight bearing, calcium intake through diet, requirements of vitamin D, as well as smoking and alcohol consumption. Consider if your own level of risk requires bone density testing. Other issues to be discussed include blood pressure, cholesterol levels, diabetes, and cancer screenings.
6. Which symptoms need prompt review, and when should I return?Inquire about heavy or extended bleeding, intermenstrual bleeding, and any post-menopausal bleeding. All require evaluation in addition to reassurance. If a therapeutic regime is initiated, discuss potential benefits, possible side effects, and scheduling for follow-up visits. Report issues that persist, rather than modifying treatments independently.The consultation must conclude with a clear plan of action, room for any questions, and a way back to health care.
