Postmenopause begins 12 months after a woman’s final menstrual period, with the average age of natural menopause occurring at 51 years.¹ Postmenopausal women can experience changes in physiology and mental health.^1–3 This time in a woman’s life provides an opportunity for the GP to undertake preventive health checks and to communicate the risks of developing osteoporosis, cardiovascular disease, and dementia associated with ageing.^1,4

Refer to other relevant chapters in the Red Book:

• Breast cancer
• Cardiovascular disease
• Cervical cancer
• Dementia
• Depression
• Frailty
• Osteoporosis
• Urinary incontinence

CVD disease risk

It is unclear if the CVD risk that is associated with the age of menopause is independent of other factors such as blood pressure or lipid profiles.⁶ However, the menopause appointment provides an opportunity to explain the elevated risk of CVD associated with early menopause, the need for increased monitoring and the importance of leading a healthy lifestyle.⁶

Hormone therapy as a preventive activity

While MHT has no net benefit for the primary prevention of chronic conditions, it has been found to increase bone density and reduce fracture risk.¹ However, prevention of osteoporosis or fracture is not a primary indication for MHT use, and it should be prescribed after the individual risk–benefits have been considered.⁵ Quality of life issues should be discussed and assessed together with the risks of developing osteoporosis, cardiovascular disease, thromboembolism, and dementia associated with ageing often coinciding with the menopause.^1,7 

Early and premature menopause

Menopause before age 45 years is regarded as ‘early’ and before age 40 years as ‘premature’.¹ 

Blood tests for diagnosis of menopause are typically not required; however, if early or premature menopause is suspected, blood tests to exclude other causes of oligomenorrhoea or amenorrhoea are appropriate.² 

In addition to an increased risk of CVD⁶, women with premature menopause may also be at higher risk of developing anxiety and or depressive disorders during menopause.¹ 

For osteoporosis screening, case finding and prevention recommendations, please refer to the Osteoporosis chapter or the RACGP and Osteoporosis Australia’s Osteoporosis prevention, diagnosis and management in postmenopausal women and men over 50 years of age.

There are no additional recommendations for this population group.