A thorough assessment of the menopausal woman should culminate in a management and/or treatment plan, outlining to the woman her options so that she may decide on choices to improve or maintain her quality of life, at the same time developing an empathic, communicating and ongoing relationship for the woman with her doctor.

In every case the woman should be advised about improving her lifestyle by having a healthy eating plan, maintaining consistent and individually appropriate physical activity and managing stress.

Smoking is particularly associated with postmenopausal morbidity and mortality.

Alongside lifestyle improvements, a therapeutic regimen may be developed which may include non-prescriptive or complementary therapies as well as prescriptive medicines.

Management plans may include:

1. Therapy for symptom relief, either hormonal or non-hormonal

2. Contraceptive advice

3. Preventative therapy eg for osteoporosis, including lifestyle, calcium, hormone therapy, vitamin D

4. Therapy for osteopenia or osteoporosis, either hormonal or non-hormonal, such as the bisphosphanates, SERMS

5. Therapy for present cardiovascular risk eg. hypercholesterolaemia

6. Referral for surgery for either pelvic or breast pathology

7. Counselling, either psychosexual or psychotherapeutic

8. Assessment of Incontinence, referral to pelvic floor rehabilitation physiotherapist.

9. Lifestyle, nutition, exercise advice as well as giving information or providing educational resources.

Regular follow-up, with two visits in the initial six months after commencing a treatment plan, provides an opportunity for both the woman and her practitioner to discuss her progress, side effects to medication or difficulties in management and treatment.

Yearly assessments should then occur. If therapy is necessary long term, annual review should occur to re-examine risks and benefits and to discuss any new options.

Content updated December 11, 2005