This guide provides a step-by-step approach to explaining a diagnosis of menopause. We have a dedicated article on the physiology of menopause. You should also read our overview of how to communicate information effectively to patients.
Structuring your explanation
Explaining a diagnosis requires structure and adequate background knowledge of the disease. Whether the information being shared concerns a procedure, a new drug, or a disease, the BUCES structure (shown below) can be used.
Opening the consultation
Wash your hands and don PPE if required.
Introduce yourself to the patient, including your name and role.
Confirm the patient’s name and date of birth.
Explain the reason for the consultation and gain consent: “Hello, I’m XX, a medical student. Can I ask for your name and date of birth, please? Today, my supervisor has asked me to come and speak with you. Is that okay?”
BUCES can be used to remember how to structure a consultation in which providing information is the primary focus. Before explaining the various aspects of a disease, it is fundamental to have a common starting point with your patient. This helps establish rapport and creates an open environment where the patient can raise concerns, ask questions and gain a better understanding of their problem.
After introducing yourself, it is important to take a brief history (this is the first part of the BUCES structure):
- What has brought the patient in to see you today?
- What are their symptoms?
- Are there any risk factors that can be identified? (e.g. lifestyle/family history)
For further information, see the Geeky Medics guide to gynaecological history taking.
Tip: Practice taking concise histories to get the timing right. In OSCE stations, timing is crucial, and you do not want to spend all your time taking a history when you are meant to explain a diagnosis! A rough guide would be to keep the introduction and brief history between 1-2 minutes maximum.
What does the patient understand?
Following a brief history, it is essential to check the patient’s prior knowledge of their condition. Patients may know someone who has already experienced menopause, or this may be their first encounter. Be open with the patient and work to identify any misconceptions they may have.
You should start with open questioning. Good examples include:
- “Have you ever heard of menopause before?”
- “Do you know anything about menopause?”
Open questioning should help you determine what the patient currently understands, allowing you to tailor your explanation to an appropriate level.
At this stage, primarily focus on listening to the patient. It may also be helpful to give positive feedback as the patient talks (e.g. should a patient demonstrate some understanding, reinforce this knowledge with encouraging words and nonverbal communication, such as nodding).
Checking the patient’s understanding should not be solely confined to this point of the consultation but should be done throughout by repeatedly ‘chunking and checking’.
Tip: Try using phrases such as, “Just to check that I am explaining menopause clearly, can you repeat back to me what you understand so far?” This is far better than only saying, “What do you understand so far?” as the onus is placed upon the quality of your explanation rather than an issue with the patient’s ability to understand.
What are the patient’s concerns?
A key component of counselling involves exploring a patient’s ideas, concerns and expectations (often referred to as ICE).
Menopause is often a significant life event that can provoke a variety of worries. Asking the patient if they have any concerns before beginning your explanation can help you determine the best approach to the information-giving section. You’ll both be able to link the information you’re giving to what the patient has already mentioned and provide reassurance on specific worries.
For example, if a patient says their main concern is whether they’ll still need to use contraception or a specific symptom like low mood, then you’ll know to focus on those topics and provide reassurance during your explanation.
The ICE (ideas, concerns and expectations) format can provide a useful structure for exploring this area further.
ICE
Ideas
- “Have you had any thoughts about what might be the cause of menopause?”
- “What is your understanding of menopause?”
Concerns
- “Is there anything in particular that concerns you?”
- “Are you worried about anything?”
- If the patient is visibly stressed: “You seem a bit troubled/anxious/nervous. Is there anything specific that’s been worrying you?”
Expectations
- “Was there anything in particular you were hoping we would discuss today?”
- “Other than finding out more about what’s going on, do you have any other expectations from your appointment today?”
- “Is there anything specific I can do or address for you today?”
Explanation
After determining the patient’s current level of understanding, you should be able to explain their condition clearly. Encourage them to ask any questions and avoid medical jargon so as not to confuse the patient.
You should begin by signposting what you will explain to give the patient an idea of what to expect.
“I’m going to begin by talking about what menopause is, then move on to discuss what some of the common symptoms people may experience are and how we can manage them.”
In preparation for your OSCE, practice explaining in patient-friendly terms. Consider using visual aids such as diagrams or drawings to help you understand.
Tip: Use the mnemonic “Normally We Can Probably Manage” to help you remember the structure of explaining a disease.
Show empathy throughout using RAV: recognise, acknowledge and validate: “It sounds like you feel frustrated with the hot flushes as they’re getting in the way of how you want to live your life. That’s completely understandable.”
Normal anatomy and physiology
Menopause is a normal part of female physiology. Before menopause, a woman will experience regular menstrual cycles, which include the menstrual period.
The menstrual cycle is controlled by two main hormones, oestrogen and progesterone, and involves several reproductive organs. The ovaries are where the eggs are stored and released, while the uterus prepares for a possible pregnancy by thickening its lining. Each cycle, an egg is released from an ovary (this is known as ovulation). If it isn’t fertilised by sperm to start a pregnancy, hormone levels fall, and the uterus lining is shed as a menstrual period.
In a healthy individual, this cycle occurs monthly unless interrupted by pregnancy, certain contraceptives or medical conditions and will continue until the hormonal changes of menopause cause a natural end in menstrual periods.1
Example
“Before menopause, your body goes through a regular monthly cycle called the menstrual cycle, which is how it prepares for a possible pregnancy.
Each month, the hormones oestrogen and progesterone cause an egg to be released from an ovary and the lining of the womb to thicken. If pregnancy doesn’t occur, hormone levels drop, and as a result of this, the womb lining will break down. This is what’s known as a menstrual period.”
What is menopause?
Explain that menopause is a normal part of ageing for most women and that it is when a woman’s menstrual periods stop due to decreased hormone levels. This means that they can no longer get pregnant.2
The transition period to menopause is called perimenopause, and it is when a woman has symptoms of menopause, but her menstrual periods have not yet stopped.3 Once a woman’s menstrual period has stopped for 12 months, she will then be considered to have reached menopause.4
Symptoms
Symptoms of the menopausal transition may include:
- Irregular periods
- Vasomotor symptoms such as hot flushes accompanied by dizziness or sweating
- Mood changes, including low mood, anxiety, increased irritability and mood swings
- Memory problems, trouble concentrating and brain fog
- Increased sleep disturbances, including increased nighttime waking associated with vasomotor symptoms
- Fatigue and tiredness
- Decreased libido
- Weight gain and bloating 4-5
Reassure the patient that there are more symptoms than those that have been mentioned. If they experience anything else, they should feel comfortable speaking with their health care provider to determine if it’s related to menopause or not.
It is also important to note that some women will experience no symptoms. Reassure the patient that this can also be normal.
Duration
Symptoms of menopause usually last between two and eight years.6 However, this is highly variable.
Example
“Menopause is a normal part of ageing that happens to all women. It’s when your periods stop completely as a result of your body gradually producing less of the hormones oestrogen and progesterone. At this stage, you can no longer become pregnant.
The period before menopause is known as the perimenopause, which is when someone has started to experience menopausal symptoms, but their menstrual periods have not stopped yet. We say that someone has reached menopause when they do not have a period for 12 months.
There are lots of symptoms that can be associated with menopause. Some common ones people experience are hot flushes, mood changes such as low mood, anxiety or mood swings, fatigue and difficulty concentrating. However, some people do not experience any symptoms, which can also be normal.
These symptoms can last for varying amounts of time, but typically last between two and eight years.
Is there anything you aren’t clear on and would like me to go over again? If not, would you mind repeating back to me your understanding of menopause so far?”
What are the causes of menopause?
Menopause usually happens naturally with age due to falling hormone levels.
In some cases, menopause can occur earlier than expected. For example, menopause can be triggered by specific medical procedures, such as surgery to remove the ovaries (oophorectomy), or treatments like chemotherapy or radiotherapy, which can affect how the ovaries function.
Menopause can also happen earlier than expected without an apparent trigger, e.g. in premature ovarian insufficiency.4
Example
“Menopause usually happens naturally with age, as the ovaries gradually stop producing the hormones oestrogen and progesterone.
In some cases, menopause can happen earlier than expected, for example, if you’ve had surgery to remove your ovaries, or treatments such as chemotherapy or radiotherapy, which can affect how the ovaries work.
Sometimes, menopause can happen earlier without a clear reason. This is sometimes known as premature ovarian insufficiency.”
Problems/complications of menopause
Potential complications of menopause include:
- Genitourinary symptoms like vaginal dryness, which can cause pain during sex, itchiness or general discomfort
- Increased risk of urinary tract infections
- Urinary incontinence
- Musculoskeletal symptoms such as joint and muscle pain, and an increased risk of osteoporotic fractures
- Increased risk of metabolic syndrome, which can include hypertension, hyperglycaemia, dyslipidaemia and central obesity, which can increase the cardiovascular risk and the risk of developing insulin resistance and diabetes 4-5, 7
Example
“Menopause can have some long-term effects on your health. These aren’t things that happen to everyone, but being aware of them can help us manage and prevent problems early on.
Some women might notice changes in the vaginal area, such as itchiness or dryness, that can cause discomfort during sex. There can also be an increased chance of urine infections or, in some cases, incontinence.
You might also experience aches or stiffness in your joints or muscles, and over time, there can be an increased risk of osteoporosis, which is where your bones become thinner and fractures can occur more easily.
There’s also the possibility of developing other changes, sometimes called metabolic syndrome. This can include high blood pressure, raised blood sugar levels, high cholesterol and weight gain around the waist. These changes can increase the risk of heart disease and type 2 diabetes.
The good news is that many of these things can be managed or even prevented through lifestyle changes, health checks and medication, depending on what works best for you.”
Management
Explain that there are both hormonal and non-hormonal options available depending on symptoms, personal preference and medical history.
See the Geeky Medics guide to hormone replacement therapy (HRT) counselling for further information.
Hormonal management
Hormonal options can include:
- Combined hormonal replacement therapy (HRT) for those with a uterus
- Oestrogen-only HRT for those without a uterus, i.e. a total hysterectomy
- Vaginal oestrogen for genitourinary symptoms 3
Non-hormonal management
Non-hormonal options include vaginal lubricants for genitourinary symptoms, antidepressants, and cognitive behaviour therapy for mood symptoms. SSRIs and SNRIs can also be used to manage hot flushes.3
Lifestyle changes and complementary therapies can help support health and manage symptoms, such as:
- Physical activity to maintain muscle mass and bone strength
- Calcium-rich foods like milk, yoghurt and kale to promote bone health
- Vitamin D through an appropriate amount of sunlight and supplements
- Light clothing and a cooling mist or fan to help with hot flushes and sweats
- Avoiding triggers for hot flushes such as spicy food, caffeine and hot drinks
- Relaxation exercises and talking therapies to help with low mood, anxiety and sleep problems
- Herbal remedies like black cohosh, red clover and evening primrose oil 4, 8
Example
“There are lots of different treatment options available for menopausal symptoms. Would you like to discuss some of them now?
Some people can use hormone replacement therapy. As part of menopause, your body produces less of your reproductive hormones, and replacing these can relieve symptoms. There are several different options available, and those which may be suitable will depend on your medical history. We can discuss some of these in more detail if you would like?
There are also lots of non-hormonal treatment options depending on the symptoms you are experiencing. For example, if you find you are having difficulty with symptoms like vaginal dryness and irritation, we can prescribe lubricants to help relieve this.
Alongside medical treatments, there are also a number of helpful lifestyle changes. For example, people who experience hot flushes may find wearing light clothing and carrying a cooling mist or fan with them is beneficial. Or relaxation exercises may help with mood or sleep problems.”
Contraception
Although fertility naturally decreases with age, contraception should still be used until menopause is established to prevent unplanned pregnancy.
The general rule regarding non-hormonal contraception is that it can be stopped in:
- Women aged ≥ 50 years after 12 months of amenorrhoea
- Women aged <50 years after 24 months of amenorrhea 9
It is also essential to remind patients that barrier contraceptive methods, such as male and female condoms, are still necessary to prevent sexually transmitted diseases.9
Example
“Even though fertility decreases with age, it is still important to use contraception until you have reached menopause to prevent unplanned pregnancy.
Generally, the guidance is that women over 50 can stop contraception after 12 months without a menstrual period.
However, even though pregnancy is not a risk once menopause is established, barrier contraception, such as condoms, is still needed to prevent sexually transmitted diseases.
Red flags
Explain that postmenopausal bleeding should always be reported to a doctor, as it could be a sign of something serious and needs to be investigated.10
Example
“If you experience any vaginal bleeding once you have reached menopause, then please speak to your doctor about it, as it can be a sign of something serious and needs investigating.”
Closing the consultation
Summarise the key points back to the patient.
“We have discussed quite a lot today, including what menopause is, the symptoms you might experience, like hot flushes and mood changes, and the different ways we can help manage them, whether through lifestyle changes or options like hormone replacement therapy. I realise it’s a lot of information to take in, so I have a leaflet summarising everything we’ve discussed. You can take it home and look through it in your own time, and of course, reach out if you have any questions.”
Ask the patient if they have any questions or concerns that have not been addressed.
“Is there anything I have explained that you’d like me to go over again?”
“Do you have any other questions before we finish?”
Direct the patient to further information about menopause using websites and leaflets (examples include the British Menopause Society).
Thank the patient for their time.
Dispose of PPE appropriately and wash your hands.
Reviewer
Dr Christos Michael DRCOG
General Practitioner
Editor
Dr Jess Speller
References
- NHS. Periods and fertility in the menstrual cycle. 2023. Available from: [LINK]
- Talaulikar V. Menopause transition: Physiology and symptoms. Clinical Obstetrics & Gynaecology. 2022. Available from: [LINK].
- NICE. Menopause: Identification and management (NG23). 2024. Available from: [LINK].
- NHS. Menopause. 2022. Available from: [LINK].
- Santoro N, Roeca C, Peters BA, et al. The Menopause Transition: Signs, Symptoms, and Management Options. The Journal of Clinical Endocrinology & Metabolism. 2020. Available from: [LINK].
- National Institute on Aging. What Is Menopause? 2024. Available from: [LINK].
- Heart UK. Cardiovascular Health: A Vital focus in Menopause Care. 2024. Available from: [LINK]
- NHS. Herbal remedies and complementary medicines for menopause symptoms. 2023. Available from: [LINK].
- Patient Info. Contraception from 40 to the menopause. 2022. Available from: [LINK].
- Patient Info. Postmenopausal bleeding. 2023. Available from: [LINK].
Discover more from Bibliobazar Digi Books
Subscribe to get the latest posts sent to your email.
