Implementing Risk Assessment Tools for Personalized Management at Menopause

Dr. Meeta Meeta

Dr. Vishal Tandon

Menopause medicine studies an adult woman passing through a transitional phase between reproductive and geriatric age groups. To practice menopause, I switched from the exciting and fast-paced role of an obstetrician and a surgeon to one of a family physician and a counselor. An immense satisfaction of bringing a smile and twinkle in the eye on a midlife woman's face replaces the thrill of delivering babies. Mastering menopausal medicine involves learning the basic knowledge and recent advances on not so familiar areas such as hypertension, diabetes, skeletomuscular health, and nutrition. Notably, constant interaction with colleagues of other disciplines and plenty of “time and patience” needs to be given to the individual woman.

Webster defines diagnosis as “the art or act of identifying a disease from its signs and symptoms.”[1] It probably needs to be redefined as “a science and art of identifying a disease from its signs and symptoms.” A myriad of information, in the form of history, clinical examination diagnostic aids are essential to reach a conclusion and formulate a plan of management. Here, risk assessment tools help in objectively organizing the data helpful in diagnosis, treatment, and research. Risk models estimate the risk of initial disease in apparently healthy, asymptomatic individuals based on the assessment of multiple variables. An ideal risk assessment tool is qualitative, simple to calculate (a pen and a piece of paper or a gadget), easy to interpret, and actionable.

A woman is unique in her biological status and responds to endogenous and exogenous factors, as distinctly as one' fingerprint. At menopause transition, the differential response to the waxing and waning of hormones is based on their biological framework, microbiota, health status, presence of comorbidities, medications, mental makeup, socioeconomic, and cultural background. Hence, the challenge is to offer a holistic and personalized approach to manage menopause. Decision-making on each menopausal treatment has a unique benefit-risk profile affecting several clinical end points. An individual's menopausal symptoms and risks for breast cancer, cardiovascular disease, skeletomuscular health, genitourinary syndrome, and other prevalent diseases and their response to treatment are dynamic and change over time with age. Moreover, the benefit-risk profile of menopausal treatment for an individual depends on the patient's baseline disease risks, concurrent use of any drug that may interact with the treatment, and the impact of that treatment on quality of life. Therefore, weighing the risks and benefits of treatment individually can be complex. It is made simple, when based on the collective assessment derived from the risk assessment models. Established tools are available to screen for menopausal symptoms, cardiovascular disease, breast cancer, skeletomuscular health, and genitourinary syndrome in establishing the health status and guide in risk-benefit analysis for prescribing menopause therapy. The paper by Calman and Royston describes risks in colloquial language, which is easy to communicate and understand, and aid in making informed decisions.[2] The risk assessment tools need to be a part of the armamentarium of a menopause practitioner. The Indian Menopause Society has described the tools for India, acknowledging the strengths and limitations.[3]

We thank Anna Fenton for a narrative review on weight, shape, and body composition changes at menopause, which will interest the readers and help in practice. In continuation of the endometrial hyperplasia series, Miland Telang and Tanvir present a pictorial review from their collection of hysteroscopic work. Each original article and the case reports are on topics of interest to the readers. We urge the readers to send their comments, and we would be happy to publish them.