What are the key considerations for managing menopause symptoms in pri

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Key considerations for managing menopause symptoms in primary care include:

Providing evidence-based information about menopause, symptoms, and treatment options to support informed decision-making, including lifestyle measures, non-hormonal treatments, and hormone replacement therapy (HRT) .
Discussing the possible duration of HRT at the outset and rediscussing benefits and risks at each review, including the potential return of symptoms if HRT is stopped and options for restarting treatment .
Offering individualized treatment choices based on age, symptoms, co-morbidities, and preferences, with the aim to prescribe the lowest effective dose for the shortest duration .
For vasomotor symptoms, offering transdermal oestradiol plus progestogen for women with a uterus, or oestrogen-only preparations for women without a uterus .
Considering HRT for genitourinary symptoms, with options including low-dose vaginal oestrogen as first-line, and discussing the safety profile, including minimal systemic absorption .
Explaining that unregulated hormone preparations and complementary therapies have uncertain safety and efficacy, and informing women about potential interactions and variable preparations .
For women with contraindications or preferences, discussing non-hormonal options such as vaginal moisturizers, lubricants, or alternative treatments like ospemifene .

What are the key considerations for managing menopause symptoms in primary care, including hormone replacement therapy options?