Management of Menopausal Symptoms
Menopause hormone therapy (MHT) has been proven to be the most effective treatment for menopausal symptoms and is an acceptable option among many women up to 59 years of age. However, consideration of other treatment options may be necessary for women who are not able or do not want to take MHT. Because of the potential risks of long-term MHT use, it is equally important to ensure that women between the ages of 60-65 years stop using MHT unless deemed appropriate. Further, breast cancer risk increases with age. Medications to reduce risk for primary breast cancer are recommended for women at increased risk, but use is low. Issues at both sides of this age spectrum (under and over 60 years) are important and require different management strategies. It is important to offer appropriate and individualized treatment options.
This project was designed to evaluate a patient-centered, shared decision making intervention in 9 primary care practices that use an Electronic Health Record (EHR) and have a wireless Internet connection. Tablet computer technology was integrated into practice workflow and results of health risk appraisal tools (menopause rating scale and breast cancer risk assessment tool) were able to be incorporated into the EHR for shared decision making at the point of care. The target audiences for this intervention are primary care providers and staff caring for women ages 45-65, and any women presenting for an appointment to her provider 45-65 years of age.
The primary aims of this study were to:
- Evaluate the impact of improved information collection and documentation of diagnosis of menopause or postmenopausal symptoms
- Assess patient and provider satisfaction with the shared decision making process
Secondary aims addressed medication use and communication between patients and providers.
This active intervention was from January 2014 through August 2015.
Data analysis is currently in progress.
Key Findings and Publications
- Tablet technology can be successfully incorporated into primary practices for patient-reported data collection and patient education. Patient-specific information and education can be used to enhance shared decision making (SDM); however, statistically significant differences were not realized in this study when tools designed specifically for menopause health were incorporated into tablet technology. Ideally, data collected would be auto-populated into the Electronic Health Record (EHR).
- Rates of menopause diagnosis and menopause medications (e.g., hormone therapy) increased for women 45-65 years when tablet technology was incorporated at the point of care during provider visits; however, these increased rates were not statistically significantly different between control and intervention groups.
- Women 45-65 years are very satisfied with their provider across several domains of the Ambulatory Care Experiences Survey (ACES) including: communication, interpersonal treatment, patient trust, whole person orientation and health promotion. Providers rated themselves lower than their patients in all domain areas. A majority of patients (88-93%) in control and intervention groups indicated complete satisfaction with the SDM process.
- Most women 45-65 years had discussions with their provider about menopause (72-77%), breast cancer risk (64-65%), and lifestyle modification (84-88%); however, there were no differences between the control and intervention groups.
- Half of the women completing the Menopause Rating Scale survey (127/252; 50.4%) indicated at least one severe to very severe somatic, psychological, and/or urogenital symptom. The most prevalent symptoms with >40% of women reporting moderate, severe, or very severe symptoms included muscular pain, sleep issues, depression, exhaustion and sexual symptoms. Moderate, severe, or very severe hot flashes/sweating were noted in only 32.3% of women.
- Most women (84-85%) indicated they enjoyed using the tablet, but it did not change their understanding of menopause symptoms and treatment.
Access the full Issue brief here(339 KB PDF) to read the detailed results and project summary.
For additional information about this study, please contact:
Laura Borgelt, PharmD, FCCP, BCPS, NCMP
Professor, Departments of Clinical Pharmacy and Family Medicine
Associate Dean of Administration and Operations
University of Colorado Anschutz Medical Campus
This study is funded by grants from Pfizer Independent Grants for Learning & Change.