Chapter 11 – Menopause

Other issues to consider

Decrease in libido 

This issue is complex and multifactorial. Factors that lead to a decrease in libido may include relationship to partner, expectations of sexual activity, competing work and family agendas, general health, and the presence of other menopausal symptoms such as dyspareunia. A discussion about sexual health should be a routine part of the menopause consultation. A biopsychosocial approach to management should be taken.(32) Management options: local vaginal therapy, in particular vaginal oestrogen, helps reduce discomfort during intercourse tibolone may help some women although data are limited transdermal oestradiol may be helpful due to a lower effect on testosterone levels than oral preparations testosterone preparations used transdermally may be considered but their use in Australia is not TGA approved and is ‘off label’ Blood levels should be monitored to ensure that testosterone levels do not exceed a normal premenopausal range

Depression, tiredness, anxiety and irritability, memory loss, poor concentration

If the patient presents with signs of depression, or there is clinical suspicion, a validated tool can be used to assist with assessment (e.g. K10 or DASS 21 may be useful). Management options: Good evidence that MHT improves these symptoms over placebo is lacking; however, some women report that their symptoms improve with use.(58) SSRIs or SNRIs may be useful ... Buy now

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