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Menopausal problems

Specialties > General practice

Differential Diagnosis Schema 🧠

Vasomotor Symptoms

  • Hot Flushes and Night Sweats: Most common symptoms; sudden, transient episodes of body warmth and sweating.
  • Sleep Disturbances: Often related to night sweats, resulting in insomnia or poor sleep quality.
  • Palpitations: May accompany hot flushes; typically benign but can cause significant discomfort.

Genitourinary Syndrome of Menopause (GSM)

  • Vaginal Dryness: Commonly due to estrogen deficiency; leads to dyspareunia and irritation.
  • Urinary Symptoms: Increased frequency, urgency, and recurrent urinary tract infections due to atrophic changes in the urethra and bladder.
  • Vulvovaginal Atrophy: Thinning of vaginal walls leading to discomfort and increased susceptibility to infection.

Psychological Symptoms

  • Mood Swings: Fluctuations in estrogen levels can cause irritability, anxiety, and depression.
  • Cognitive Changes: Issues with memory, concentration, and mental clarity; often referred to as “brain fog”.
  • Reduced Libido: Decreased sexual desire, often linked to both hormonal changes and physical discomfort from GSM.

Musculoskeletal Symptoms

  • Joint and Muscle Pain: Estrogen deficiency can contribute to generalized aches and pains, particularly in the joints.
  • Osteoporosis: Increased risk due to decreased bone density; consider in patients with history of fractures or risk factors for osteoporosis.

Key Points in History 🥼

Symptomatology

  • Onset and Duration: Typical menopausal symptoms often begin during perimenopause and can persist for several years post-menopause.
  • Severity and Impact: Assess how symptoms affect daily life, including sleep, work, and relationships.
  • Menstrual History: Irregular periods, amenorrhea, and heavy bleeding can signal the transition into menopause.
  • Sexual Health: Inquire about changes in sexual function, dyspareunia, and libido.

Background

  • Past Medical History: Important to note any history of cardiovascular disease, osteoporosis, or hormone-sensitive cancers.
  • Drug History: Review current medications, especially hormone replacement therapy (HRT), and any contraindications.
  • Family History: A history of osteoporosis or early menopause in family members can be relevant.
  • Social History: Consider lifestyle factors such as smoking, alcohol use, diet, and exercise, which can influence symptoms and risk factors.
  • Psychosocial Factors: Assess the impact of menopausal symptoms on mental health, relationships, and overall quality of life.

Possible Investigations 🌡️

Laboratory Tests

  • Follicle-Stimulating Hormone (FSH) Levels: Elevated FSH is consistent with menopause but not routinely required for diagnosis.
  • Thyroid Function Tests: Rule out hypothyroidism, which can mimic menopausal symptoms.
  • Lipid Profile: Assess cardiovascular risk, as menopause is associated with increased risk of heart disease.
  • Bone Mineral Density (BMD) Scan: Consider DEXA scan in women at risk of osteoporosis, especially if they have risk factors or a history of fractures.

Imaging and Specialist Tests

  • Pelvic Ultrasound: Used to investigate abnormal uterine bleeding; assess endometrial thickness and rule out pathology.
  • Mammography: Routine screening in women aged 50-70; earlier if there is a family history of breast cancer or other risk factors.
  • Cardiovascular Assessment: Consider ECG or echocardiogram if cardiovascular disease is suspected based on risk factors or symptoms.

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General practice