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Menopause

Definition of menopause provided by NICE

Menopause – a biological stage in a woman’s life that occurs when she stops menstruating and reaches the end of her natural reproductive life. Usually, it is defined as having occurred when a woman has not had a period for 12 consecutive months (for those reaching menopause naturally). The changes associated with menopause occur when the ovaries stop maturing eggs and secreting oestrogen and progesterone.

Perimenopause – the time in which a woman has irregular cycles of ovulation and menstruation leading up to menopause and continuing until 12 months after her final period. The perimenopause is also known as the menopausal transition or climacteric.

Postmenopause – the time after menopause has occurred, starting when a woman has not had a period for 12 consecutive months.

The British Menopause Society (BMS) produce a helpful resource for all clinicians, the ‘What is the menopause?‘ factsheet.

Early Menopause 

Menopause before the age of 45 is differentiated as either early or as Premature Ovarian Insufficiency (POI) if aged 40 years or younger.

If periods cease between 40-45 years, alongside a change in the menstrual cycle and menopause-type symptoms, early menopause is indicated.

Premature Ovarian Insufficiency (POI) is oligomenorrhoea / amenorrhoea (no periods) of more than 4 months duration, with elevated hormonal blood tests (gonadotropins FSH >40 iu/l) on at least two occasions 4-6 weeks apart in people under the age of 40. For clarity see NICE guidance ​here.

Royal Colleges: Position Statements

Menopause Training

The British Menopause Society (BMS) offers the following training:

  • A selection of introductory ‘shorts’ here
  • The BMS resources library which includes links to prescribing guidelines/alternatives, practice standards and lifestyle advice here
  • Specific healthcare professional training from basic principles to the advanced practitioner courses here
  • The specific BMS courses designed for nurses accessed here
  • The BMS also links to IMPART; International activity for refresher training via IMS IMPART.

FourteenFish provides a course covering all aspects of menopause to build confidence, know when to refer, symptoms management strategies, free for all healthcare professionals via  this link

Red Whale provide online courses and Podcasts directed at Primary Care Professionals for varied cost levels accessed here

For continued professional development, see the BMS Reproductive Health Journal It is also important to note that formal training and experiential learning are both critical to knowledge development and confidence in management.

Specialist Training

The BMS defines a specialist as:

A healthcare professional who has obtained the British Menopause Society (BMS)/Faculty of Sexual Reproductive Health (FSRH) Advanced Menopause Certificate, or completed the (Royal College of Obstetrics and Gynaecology (RCOG)/BMS Advanced Training Skills Module (ATSM – only available for medical staff)* in Menopause Care (or equivalent, for example, the menopause and premature ovarian failure module of the subspecialty training programme in reproductive medicine)

and who:

  1. Is a member of the British Menopause Society (BMS)
  2. Attends a National (BMS), European or International Menopause Society conference at least once every three years (BMS, 2018)
  3. Provides a minimum of 100 menopause-related consultations per year, of which at least 50 are new
  4. Has the responsibility documented as part of their job plan and discussed at their annual appraisal.

Health professionals wishing to register as a specialist do so at the British Menopause Society. Re-certification with BMS is required every three years, when specialists will be asked to confirm that they still fulfil the criteria.

Looking after our menopausal workforce

Nurse Specialist in Menopause RCN paper

Menopause guidance from RCN

Practitioners Toolkit

There are specific symptoms that are difficult to manage, some as a result of the complexities between menopause and exacerbation. Mental health issues are one such example. This is picked up within the Practitioner’s Toolkit for Managing Menopause which gives guidance on assessment and treatment.

Longitudinal studies (SWAN) and the International Menopause Society (IMS) recommend that clinicians should differentiate between depression and low mood associated with hormonal changes experienced at menopause for the first time.

Many women will have an exacerbation of Major Depressive Disorder (MDD) during the Menopause Transition (MT). Women with moderate to severe Vaso Motor Symptoms (VMS) are up to three-fold more likely to have moderate–severe depressive symptoms than other women. Treating VMS will facilitate better sleep, therefore preventing consistent sleep disruption which can impact mood.

Professor Pauline Maki underlines the process for Treating perimenopausal depression:

  1. Explore previous episodes of mental health
  2. Differentiate and treat if this is a hormonal response