Guidelines for preventive activities in general practice

Reproductive and women’s health

Postmenopause

      1. Postmenopause

Reproductive and women's health| Postmenopause

Postmenopause begins 12 months after a woman’s final menstrual period, with the average age of natural menopause occurring at 51 years.1 Postmenopausal women can experience changes in physiology and mental health.1–3 This time in a woman’s life provides an opportunity for the GP to undertake preventive health checks and to communicate the risks of developing osteoporosis, cardiovascular disease, and dementia associated with ageing.1,4

Refer to other relevant chapters in the Red Book:

Preventive activities and advice

Recommendation Grade How often References
The onset of menopause is an opportunity for a routine health assessment, education and primary prevention in regard to general health and wellbeing, including cardiovascular, bone and mental health. Practice point N/A 1
Using menopausal hormone therapy (MHT), combined estrogen and progestin or estrogen alone for the primary prevention of cardiovascular disease (CVD) or other chronic conditions* is generally not recommended. Refer to further information.
*Coronary heart disease, breast cancer, fractures, diabetes, colorectal cancer, thromboembolic events, stroke, dementia, gallbladder disease, urinary incontinence all-cause mortality.
Generally not recommended N/A 1,4,5

CVD disease risk

It is unclear if the CVD risk that is associated with the age of menopause is independent of other factors such as blood pressure or lipid profiles.6 However, the menopause appointment provides an opportunity to explain the elevated risk of CVD associated with early menopause, the need for increased monitoring and the importance of leading a healthy lifestyle.6

Hormone therapy as a preventive activity

While MHT has no net benefit for the primary prevention of chronic conditions, it has been found to increase bone density and reduce fracture risk.1 However, prevention of osteoporosis or fracture is not a primary indication for MHT use, and it should be prescribed after the individual risk–benefits have been considered.5 Quality of life issues should be discussed and assessed together with the risks of developing osteoporosis, cardiovascular disease, thromboembolism, and dementia associated with ageing often coinciding with the menopause.1,7 

Early and premature menopause

Menopause before age 45 years is regarded as ‘early’ and before age 40 years as ‘premature’.1 

Blood tests for diagnosis of menopause are typically not required; however, if early or premature menopause is suspected, blood tests to exclude other causes of oligomenorrhoea or amenorrhoea are appropriate.2 

In addition to an increased risk of CVD6, women with premature menopause may also be at higher risk of developing anxiety and or depressive disorders during menopause.1 

For osteoporosis screening, case finding and prevention recommendations, please refer to the Osteoporosis chapter or the RACGP and Osteoporosis Australia’s Osteoporosis prevention, diagnosis and management in postmenopausal women and men over 50 years of age.

 
 

There are no additional recommendations for this population group.

Guideline for the prevention, assessment, diagnosis, treatment and management of osteoporosis in Australia:
Osteoporosis prevention, diagnosis and management in postmenopausal women and men over 50 years of age | RACGP and Osteoporosis Australia
 
The following includes a flowchart to assess if the patient is pre-/peri-/postmenopausal:
A practitioner’s toolkit for the management of the menopause | Monash University School of Public Health and Preventive Medicine
  1. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Managing menopausal symptoms. RANZCOG, 2020. Available at: [Accessed 13 April 2024].
  2. Magraith K, Stuckey B. Making choices at menopause. Aust J Gen Pract 2019;48(7):457–62. doi: 10.31128/AJGP-02-19-4851.
  3. Dalal PK, Agarwal M. Postmenopausal syndrome. Indian J Psychiatry 2015;57(Suppl 2):S222–32. doi: 10.4103/0019-5545.161483.
  4. Gartlehner G, Patel SV, Reddy S, Rains C, Schwimmer M, Kahwati L. Hormone therapy for the primary prevention of chronic conditions in postmenopausal persons: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2022;328(17):1747–65. doi: 10.1001/jama.2022.18324.
  5. Hemachandra C, Taylor S, Islam RM, Fooladi E, Davis SR. A systematic review and critical appraisal of menopause guidelines. BMJ Sex Reprod Health 2024:bmjsrh-2023-202099. doi: 10.1136/bmjsrh-2023-202099. Epub ahead of print. PMID: 38336466.
  6. Department of Health and Aged Care. Australian guideline for assessing and managing cardiovascular disease risk. Department of Health and Aged Care, 2023 [Accessed 7 April 2024].
  7. The Royal Australian College of General Practitioners and Osteoporosis Australia. Osteoporosis prevention, diagnosis and management in postmenopausal women and men over 50 years of age. 2nd edn. RACGP, 2017.
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  Lifecycle-chart.pdf (PDF 0.12 MB)

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