Practitioner-Patient Communication on Menopause

By Monazza Ahmad, B.Pharm, MSc

To ensure best health outcomes in a healthcare setting, it is important to establish open, effective, and respectful communication between a patient and a healthcare practitioner.

As a patient, it is not only your right but in your best interest to ask your doctor for clarification or further explanation on your health condition and treatment plan. As a healthcare provider, it is your responsibility to provide a safe and comfortable environment for your patients to openly discuss their health concerns and make sure your diagnosis and treatment plan is well understood.
That said, menopause can trigger many complex and confusing symptoms that can be uncomfortable to talk about, which can make managing the symptoms difficult. Here are some tips for both patients and practitioners to start the conversation around menopause and its symptoms that we discussed in our previous post, Menopausal Symptoms.

When should I talk to my doctor about menopause?1
First of all, don’t feel awkward. Menopause is a natural phase of life, and your doctor is likely familiar with all possible symptoms. Describe your condition and symptoms in detail and explain how they are affecting your lifestyle and relationships. The provider needs to rule out any other underlying conditions before determining it is menopause.
Reach out to your doctor if:

• You haven’t had your period for two consecutive months
• You have more than one period in a month or your cycle is unusually irregular
• You have uncomfortable vaginal dryness
• The symptoms are interfering with your daily activities
• The symptoms are affecting your sexual life and intimate relationship
• You consistently get brain fog and feel sad
• You often start sweating suddenly, and it doesn’t feel normal
• You are gaining weight unusually
• Other therapies are not helping with the symptoms

Don’t forget to tell your doctor if you have any allergies or other health conditions. Also mention any medications or supplements you’re already taking for menopause symptoms or other conditions.

What shall I ask my doctor?
Medical appointments can be stressful, and we often feel rushed. When you have a delicate issue to bring up, being prepared can help. Here are some of the questions you can ask your practitioner:

1. How do I know when I start menopause?
2. What is the difference between perimenopause, menopause, and postmenopause? And how do I know which phase I am going through?
3. What are the different challenges of each phase?
4. How can I tell hot flashes apart from normal sweating?
5. What can I do to relieve my symptoms such as hot flashes and vaginal dryness?
6. Why do I feel so much menopausal anxiety, and how can I overcome this?
7. What are my treatment options, and how long does each option takes to work?
8. Are there any side effects with these options?
9. What are the safe, nonhormonal solutions to manage menopausal symptoms that I can try first?
10. When should I seek further medical assistance?

How can healthcare providers ensure the right care during menopause?
Often, the reluctance from healthcare professionals to address these female issues can also cause lack of awareness. It is the healthcare provider’s obligation to make sure patients feel comfortable in discussing their menopausal concerns and understand the treatment plan.2
According to a survey by NIH, patients are likely to discuss menopause transition with providers who don’t make them feel rushed, are good listeners, and have expertise in this area of women’s health.
Here are some ways to help your patients receive the best care:

1. Keep your tone friendly.
2. Be empathetic and sensitive about their health challenges.
3. Use plain language and avoid medical jargon (do not assume that your patients are familiar with the complex medical terms).
4. Create communication material beforehand at 5th– to 8th-grade level of understanding.
5. Give women time to reflect and find words to articulate concerns.
6. Ask both closed-ended and open-ended questions to discover more.
7. Make sure to ask if they understand the treatment plan and what concerns they have about the treatment options or compliance. Offer to repeat the plan.

​What to ask your patients:3

• Do you get sudden outbursts of sweat to the level that it makes you feel embarrassed?
• Do you have vaginal dryness accompanied with discomfort, and is it affecting your sexual life?
• Do you get brain fog and feelings of sadness? What do you feel like when this happens? How do you cope with it?
• Do you feel a lack of interest in daily activities? What does your day look like?
• Do you have any concerns about the treatment plan we discussed?
• Do you want me to go over the treatment plan again?

The menopausal rating scale and symptoms evaluation form can be used to track symptom improvement to see what treatment options are working:4,5

Menopause symptoms evaluation form and rating scale (click to enlarge)Menopause is a natural phase in a woman’s life, and its challenges need to be accepted and understood at work, at home, and on a social as well as a societal level. Unless these concerns are progressively communicated in a healthcare setting, it will be tough for us to understand the impact of this condition on a woman’s life.

​References:

1. Sachdev P. Talking to your doctor about menopause. https://www.webmd.com/menopause/guide/menopause-talking-to-doctor. Accessed May 16, 2023.
2. Angelou K et al. The genitourinary syndrome of menopause: an overview of the recent data. Cureus. 2020;12(4):e7586.
3. Newson L et al. Guidance on diagnosis and management of urogenital atrophy or genitourinary syndrome of the menopause (GSM). https://pcwhf.co.uk/wp-content/uploads/2018/11/GSM-Guideline.pdf. Accessed May 16, 2023.
4. Heinemann K et al. The Menopause Rating Scale (MRS) scale: A methodological review. Health Qual Life Outcomes. 2004;2:45.
5. Hauser GA et al. About MRS. https://zeg-berlin.de/expertise/diagnostics-tools/menopause-rating-scale/about-mrs/. Accessed May 16, 2023.