Menopause (New Diagnosis)

Jane Snow

48 years, Female

Role-play cases simulate real clinical practice to guide how candidates respond to clinical scenarios and real life practice.

Name: Jane Snow
Age: 48 years
Gender:Female

Opening Statement
"Doctor please I want to have my hormone bloods done and to talk about starting HRT."

Open History:

Experiencing hot flushes, insomnia, mood swings, and brain fog for the past 2 years, worsening recently.
No vaginal symptoms (dryness or frequency).
Low libido, no marital problems.
Irregular periods occurring every 2 to 3 months.
No family or personal history of breast, ovarian, uterine, or vulva cancers.
Up to date with cervical smears and breast aware.

Social History:

Works as an accountant manager; struggles with hot flushes during meetings and brain fog, needing reminders for tasks.
Has two children (15-year-old boy and 17-year-old girl) doing well in school.
Home life is good with a supportive family and a pet dog.
Does not drink alcohol or smoke cigarettes.
Regularly goes to the gym (3 times a week).

Medical History:

Depression: Ongoing. Controlled with medication

Medications: you are well informed of your medication.

Vortioxetine: 10mg daily.

ICE (Ideas, Concerns, Expectations):

Ideas: Believes symptoms are due to menopause.
Concerns: Mother took her life at age 48, believed to be due to menopause, fears the same outcome.
Expectations: Blood tests for hemophilia follow-up, information on HRT (especially the patch), prescription for tranexamic acid.

How to Act:

Interested in trying HRT, specifically the patch as recommended by a friend.
Willing to accept a follow-up appointment or prescription today.
Open to receiving informational leaflets about HRT.

You are a doctor in your routine clinic, ready to begin your day of consultations. A patient has been booked to see you,

Name: Jane Snow

Age: 48 years

Gender:Female

Past Medical History

•Depression

•Haemophilia

Medication

•Vortioxetine 10mg daily

•Tranexamic Acid 500mg

eConsult Sent 21/7/2024

Request for blood tests, says struggling with brain fog, agrees to telephone appointment to discuss with GP. Appointment booked.

Key Issues in Managing the Case of Jane Snow

Menopause Symptom Management:
Assessment of Symptoms: Evaluate the severity and impact of hot flushes, insomnia, mood swings, and brain fog on daily life and work.
Hormone Replacement Therapy (HRT): Discuss the benefits, risks, and different forms of HRT, particularly the patch which Jane is interested in.
Monitoring and Follow-Up: Plan regular follow-ups to monitor response to HRT, manage any side effects, and adjust the treatment as necessary.

Mental Health:History of Depression: Consider the impact of menopause on her mental health, given her history of depression and the traumatic history of her mother’s suicide potentially linked to menopause.
Psychological Support: Ensure access to mental health support and consider involving a mental health professional if needed.

Haemophilia Management:
Blood Tests: Conduct the requested blood tests to monitor haemophilia for her upcoming haematologist appointment.
Medication Management: Review and renew prescription for tranexamic acid to manage haemophilia symptoms.

Medication Review
Current Medications: Ensure that her current medications (Vortioxetine and Tranexamic Acid) are appropriately managed and do not interact adversely with any new medications.
HRT Safety: Evaluate the safety of starting HRT given her medical history, including depression and haemophilia.

Social and Occupational Impact:
Work Stress: Address how menopause symptoms are affecting her performance and stress levels at work, and provide strategies to manage these issues.
Support Systems: Consider the role of family support in her care, particularly her relationship with her children and the impact of her mother's history.

Preventative Health:Screening and Monitoring: Ensure she is up to date with cervical smears and other preventative health measures, given her heightened awareness of breast cancer and other related health concerns.

Patient Education and Empowerment:Information on Menopause and HRT: Provide comprehensive information on menopause and the potential benefits and side effects of HRT.

Decision-Making: Involve Jane in the decision-making process, respecting her preferences and ensuring she feels supported in her choices.

Lifestyle Considerations:Exercise and Nutrition: Encourage healthy lifestyle practices, including regular exercise and a balanced diet, which can help manage menopause symptoms.

Non-Pharmacological Interventions: Discuss other strategies for managing menopause symptoms, such as cognitive behavioral therapy for insomnia or stress management techniques.

These are the key issues in this clinical scenario.

Marking Scheme for the Case of Menopause and HRT Request
1. Data Gathering

Good Indicators:

Comprehensive History Taking:Asks about the nature, duration, and severity of menopause symptoms (hot flushes, insomnia, mood swings, brain fog).
Inquires about menstrual history, including changes in frequency and regularity of periods.
Checks for any vaginal symptoms such as dryness or discomfort.
Asks about personal and family history of breast, ovarian, uterine, and vulva cancers.
Explores the impact of symptoms on daily life, work, and social activities.

Psychological History:Asks about current mental health status and any history of depression or other mental health issues.
Inquires about the emotional impact of menopause symptoms and any related concerns or fears.

Medical History:Reviews current medications and checks for any contraindications to HRT.
Asks about past medical history, including any chronic conditions and their management.
Specifically asks about haemophilia and its management.

Lifestyle and Social History:Explores the patient's work environment and its impact on symptoms.
Inquires about support systems, including family, friends, and social activities.
Asks about lifestyle factors such as exercise, diet, smoking, and alcohol use.

Negative Indicators:

Incomplete History Taking: Fails to ask about the nature and impact of menopause symptoms.
Omits questions about menstrual history and changes.
Neglects to ask about personal and family history of relevant cancers.
Does not explore the impact of symptoms on daily life and work.

Psychological and Medical History: Fails to inquire about current mental health status and history of depression.
Omits questions about current medications and potential contraindications.
Does not ask about haemophilia and its management.

Lifestyle and Social History: Neglects to ask about work environment and its impact on symptoms.
Fails to inquire about support systems and social activities.
Does not ask about lifestyle factors such as exercise, diet, smoking, and alcohol use.

2. Interpersonal Skills
Good Indicators:

Empathy and Understanding: Shows empathy and understanding towards the patient's symptoms and concerns.
Validates the patient's experiences and feelings about menopause and its impact on her life.

Communication: Uses clear and simple language to explain medical concepts and treatment options.
Ensures the patient understands the information provided and checks for comprehension.
Allows the patient to express her concerns and questions without interruption.

Support and Reassurance: Provides reassurance about the management of menopause symptoms and the effectiveness of HRT.
Offers support and resources for managing symptoms and improving quality of life.
Encourages the patient to be involved in decision-making about her treatment.

Negative Indicators:

Lack of Empathy:Shows a dismissive or unsympathetic attitude towards the patient's symptoms and concerns.
Fails to acknowledge the emotional impact of menopause on the patient's life.

Poor Communication:Uses medical jargon without explaining it in simple terms.
Does not check for the patient's understanding of the information provided.
Interrupts the patient or fails to allow her to express her concerns and questions.

Insufficient Support:Fails to provide reassurance about the management of menopause symptoms.
Does not offer resources or support for managing symptoms.
Does not involve the patient in decision-making about her treatment.

3. Clinical Management
Good Indicators:

HRT Discussion:Explains the benefits and risks of HRT in a balanced manner.
Discusses different forms of HRT (e.g., patches, pills) and their respective pros and cons.
Reviews the patient's suitability for HRT, considering her medical history and current medications.

Mental Health Management:Addresses the patient's history of depression and its potential interaction with menopause symptoms.
Offers mental health support and referrals if necessary.

Haemophilia Management:Orders appropriate blood tests to monitor haemophilia and ensures ongoing management.
Reviews and renews the prescription for tranexamic acid.

Lifestyle and Preventative Measures:Encourages healthy lifestyle practices, such as regular exercise and a balanced diet.
Provides information on non-pharmacological interventions for managing menopause symptoms.
Ensures the patient is up to date with cervical smears and other preventative health measures.

Follow-Up:Plans regular follow-ups to monitor response to HRT and adjust treatment as needed.
Schedules follow-up appointments to review blood test results and overall progress.

Negative Indicators:

Inadequate HRT Discussion:Fails to explain the benefits and risks of HRT.
Does not discuss different forms of HRT or tailor the options to the patient's preferences.
Does not review the patient's suitability for HRT considering her medical history.

Neglecting Mental Health:Does not address the patient's history of depression or its potential impact on menopause symptoms.
Fails to offer mental health support or referrals.

Haemophilia Management:Does not order necessary blood tests to monitor haemophilia.
Fails to review or renew the prescription for tranexamic acid.

Lifestyle and Preventative Measures:Does not encourage healthy lifestyle practices or provide information on non-pharmacological interventions.
Neglects to ensure the patient is up to date with cervical smears and other preventative health measures.

Follow-Up:Does not plan regular follow-ups to monitor response to HRT and adjust treatment.
Fails to schedule follow-up appointments to review blood test results and overall progress.

Tips for Effective Consultation in HRT Request Case

Comprehensive History: Thoroughly ask about menopause symptoms, menstrual changes, and their impact on daily life.
Inquire about any previous mental health issues and current medications, including their effects.

Clear Communication :Explain HRT options, benefits, and risks in simple, understandable terms.
Ensure the patient understands the information and answer any questions clearly.

Empathetic Approach:Show empathy towards the patient’s symptoms and concerns.
Validate their experiences and provide reassurance about treatment options.

Holistic Management:Discuss lifestyle changes and non-pharmacological interventions alongside HRT.
Address mental health and other health concerns, like haemophilia, comprehensively.

Follow-Up Plan:Set up regular follow-ups to monitor HRT effectiveness and adjust treatment as needed.
Schedule additional appointments to review test results and overall health.