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'Simple, fast' tool for PCPs to help patients manage menopause
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Citing the “needs of busy primary care physicians,” a family physician recently developed Menopause Quick 6, or MQ6, a tool to help these medical professionals treat patients going through menopause.
By the year 2020, the number of U.S. women older than age 51, the average age at which menopause occurs naturally, is expected to be more than 50 million, according to the North American Menopause Society. Previous research suggests many women continue to experience “substantial” menopausal symptoms well into their 60s.
“Many older clinicians have defaulted to delegating mature women's care to OB/GYNs or avoid it altogether, where our younger clinicians have had little teaching or experience during their training with respect to menopausal care. In lecturing to primary care physicians, it became very evident that there was a large knowledge gap related to assessment and treatment of menopause that needed to be addressed,” Susan Goldstein, MD CCFP, FCFP, NCMP, department of family and community medicine, University of Toronto, told Healio Family Medicine in an interview. “Our physicians have little training on how to organize their approach to menopausal treatment, including the relevant questions to ask. This tool guides clinicians in what to ask, and the [patient’s] answers then inform management options.”
The MQ6, which Goldstein said takes 2 minutes to administer in perimenopausal patients, revolves around six questions:
- Any changes in your periods?
- Are you having any hot flashes?
- Any vaginal dryness or pain, or sexual concerns?
- Any bladder issues or incontinence?
- How is your sleep?
- How is your mood?
Patients who answer yes to any of the first four questions,may be a candidate for menopausal hormone therapy, according to Goldstein.
“There are a number of longer, more detailed instruments, such as the Greene Climacteric Scale or the Menopause Rating scale. [However] these are more complex, take longer to complete and in my opinion, are more useful for research while perhaps less practical for primary care,” Goldstein said. “In contrast, my tool is simple, fast, sensitive without being overly specific, and written in lay language [that is] intended to elicit a meaningful response from patients.”
She indicated using the tool is beneficial for the medical professional and the patient.
“Using the MQ6 ensures that clinicians are asking the right questions in a standardized way. The accompanying algorithm, guided by the answers to the MQ6, is based on the latest evidence-based guidelines and can facilitate clinical decisions in an area that has a controversial and sometimes confusing history. From the patient perspective, using these tools can help patients engage to discuss sensitive issues and it reassures them they are being cared for in a holistic manner,” Goldstein wrote. – by Janel Miller
Reference:
"Menopause Practice: A Clinician's Guide, 4th edition." The North American Menopause Society, 2010. Accessed June 16, 2017.
Disclosure: Goldstein reports receiving honorarium fees for advisory board participation and consultant fees from Pfizer and Merck.
Perspective
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Carolyn Wilson, MD, NCMP
Since 2002, when the initial results from the Women’s Health Initiative was published, both providers and women have been fearful of using hormone therapy. As there are new guidelines, primary care providers and OB/GYNs need to have a structured approach to asking about menopausal concerns.
In the 2017 North American Menopause Society’s (NAMS) Hormone Therapy Position Statement, more than 23 U.S., Canadian and Mexican experts reviewed all current literature on hormone therapy to identify appropriate candidates for therapy. Hormone therapy is the most effective treatment for menopausal symptoms when initiating therapy younger than age 60 or within 10 years of menopause. Having an evidence-based algorithm such as the MQ6 helps providers ask menopausal women appropriate questions and provide up-to-date therapy when indicated. The tool itself is a great start, as it is easy to use and asks key questions.
Deciding therapy options for less straightforward women or those who need nonhormonal therapy is more complicated than depicted, and extended use was not addressed. Another important therapy not discussed is the primary use of systemic hormone therapy for women at elevated risk for bone loss and fractures. Additionally, vaginal estrogen alone is sufficient therapy for many women with only vaginal concerns, such as dyspareunia, vaginal dryness or recurrent UTIs.
For providers who want access to recent evidence based guidance or referrals to NAMS Certified Menopause Practitioners, we direct them to the 2017 NAM HT PS and the NAMS webpage http://menopause.org/.
References:
1. Rossouw JE, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA. 2002; 288(3):321–33.
2. North American Menopause Society. The 2017 hormone therapy position statement of The North American Menopause Society [published online ahead of print June 20, 2017]. Menopause. doi:10.1097/GME.0000000000000921.
3. Goldstein S. An efficient tool for the primary care management of menopause. Can Fam Physician. 2017 Apr;63(4):295-298.
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