CPD learning module: HRT and diagnosing the menopause

This case-based module by Toni Hazell will guide you through the latest evidence in the diagnosis and management of the menopause 

The menopause is defined as ‘a biological state in a woman’s life when menstruation stops permanently due to the loss of ovarian follicular activity’. The mainstay of management of menopausal symptoms is hormone replacement therapy (HRT), which replaces the hormone oestrogen, but there are some other options for women who do not wish to take HRT, or have a medical contra-indication to it. 

This case-based learning module will update you on:

• How to diagnose the menopause and the perimenopause 
• What to say to a woman who is worried about the risks of breast cancer with hormone replacement therapy
• Which type of HRT to use for which woman
• Non-hormonal alternatives to HRT, including herbal medicines

Case Study – Miss P 

Related Article: ‘Concerning acceleration’ in drug-resistant gonorrhoea ahead of vaccine programme

Miss P is a 48 year old woman who you are seeing in your role as a nurse practitioner with an interest in women’s health. She walks into your room, sits down, takes a deep breath and bursts into tears.

She is worried that she might be menopausal. Her last period was six months ago, and she has done several pregnancy tests which were all negative. She feels very sweaty at night and is having hot flushes during the day. She then goes on to say that she wonders if she is depressed as she is anxious all the time, can’t concentrate at work (which has led to her being performance managed) and is shouting at her children more than usual. She also feels aches in her muscles and joints and has more headaches than usual.

She is tired all the time and is ‘at the end of my tether’. 

You agree that she might be menopausal – what do you do next? 

Miss P’s symptoms are all consistent with the menopause. As well as vasomotor symptoms (hot flushes/night sweats), the menopause can cause cognitive impairment, mood disorders, urogenital symptoms, altered sexual function, sleep disturbance, joint pain, headaches and fatigue. 

You explain to Miss P that you think she is going through the perimenopause and ask if she wants to start HRT. She looks horrified and tells you that she has heard that HRT gives you breast cancer. 

Do you know any statistics about HRT and breast cancer which you could use to reassure Miss P? 

Related Article: Action needed to tackle untreated hearing loss in care homes 

Miss P says that she is strongly considering HRT, but she wants to think about it a bit more. 

Do you have any information that she can read, and can you tell her about the alternatives to HRT which don’t involve hormones?

Author

Toni Hazell is a GP in North London.

Finding the module

Related Article: Government to introduce HPV self-sampling for ‘under-screened’ women

The full module can be found on the Nursing in Practice Learning website.

Not a Nursing in Practice Learning member? Click here to register for free and gain access to more CPD modules.