When should I consider referring a patient for specialist evaluation regarding menopausal management?

Consider referring a patient for specialist evaluation regarding menopausal management if:

• The woman has ongoing menopausal symptoms despite lifestyle measures and hormonal, non-hormonal, or non-drug treatments being ineffective.
• There are persistent, troublesome adverse effects from menopausal treatments.
• There is uncertainty about the most suitable treatment option due to co-morbidities and/or contraindications to treatment.
• The woman has persistent altered sexual function and hormonal and/or non-hormonal or non-drug treatments are ineffective; specialist advice may be needed regarding testosterone supplementation and psychosexual counselling.
• There is suspicion or diagnosis of premature ovarian insufficiency, or psychological support is needed for early menopause.
• The woman has a personal history of, or is at high risk of, breast cancer and requires assessment of menopause management options.
• There is a sudden change in menstrual pattern, intermenstrual bleeding, postcoital bleeding, or postmenopausal bleeding, especially if gynaecological cancer is suspected, warranting urgent referral.
• The woman is at high risk of venous thromboembolism (VTE) and needs haematologist assessment before considering hormone replacement therapy (HRT).
• The woman has cardiovascular disease or significant cardiovascular risk factors requiring specialist input on HRT use.
• The woman is likely to experience menopause due to medical or surgical treatment and needs expert discussion about menopause and fertility.

Referral to a healthcare professional with expertise in menopause is recommended in these situations to ensure individualized, safe, and effective management of menopausal symptoms and associated health risks.

NICE CKS,NICE NG23,NICE CKS