Bone Health:
- Assess early fracture risk factors, including history, dietary calcium and vitamin D intake, and physical activity level.
- Reinforce weight-bearing exercise and a calcium enriched diet with adequate vitamin D supplementation to help maintain bone mineral density.
- Encourage smoking cessation and reduced alcohol consumption to prevent early bone loss.
Linked guideline: Guideline No. 422g: Menopause and Osteoporosis
Cardiovascular Health:
- Monitor cardiovascular and metabolic disease risk factors.
- Review prevention strategies related to elevated cardiovascular disease risk in premature or early menopause.
- Encourage heart-healthy diet, physical activity, and lifestyle modifications to decrease cardiovascular disease risk where appropriate.
- Counsel on the importance of smoking cessation and reduced alcohol consumption.
Linked guideline: Guideline No. 422e: Menopause and Cardiovascular Disease
Genitourinary Health:
- Provide information about the progressive impact of estrogen deficiency on urogenital health (such as vaginal dryness, irritation, impaired sexual function, or urinary symptoms [including urinary tract infection]) and the many options available for symptom relief.
- Offer first-line management options for genitourinary syndrome of menopause; may include vaginal lubricants and/or vaginal moisturizers.
Linked guideline: Guideline No. 422b: Menopause and Genitourinary Health
Sexual Health:
- Include a sexual screening history and physical examination in the initial evaluation, in patients with sexual concerns, as guided by clinical need/discussion.
- Categorize symptoms as related to desire, arousal, pain, or orgasm, in order to facilitate treatment and to triage care.
- Suggest vaginal estrogens, lubricants and moisturizers, and pharmacotherapies as treatments for vaginal atrophy related to menopause.
Linked guideline: Guideline No. 422d: Menopause and Sexuality
Lifestyle Modifications:
- Encourage a healthy diet and lifestyle to reduce the risk of future chronic conditions, improve symptoms, aid in weight management, and improve energy levels.
- Recommend a calcium-rich diet, adequate vitamin D, and increased vegetable intake.
- Promote regular weight-bearing and aerobic exercise, smoking cessation, and reduced alcohol consumption.
Linked guidelines: Guideline No. 422a: Menopause: Vasomotor Symptoms, Prescription Therapeutic Agents, Complementary and Alternative Medicine, Nutrition, and Lifestyle, Guideline No. 422c: Menopause: Mood, Sleep and Cognition, Guideline No. 422e: Menopause and Cardiovascular Disease, Guideline No. 422g: Menopause and Osteoporosis
Menstrual Cycle:
- Document cycle length, regularity/variability, and bleeding heaviness.
Source: SOGC Menopause Hub
Vasomotor Symptoms:
- Ask specifically about vasomotor symptoms (hot flashes and/or night sweats), including frequency and impact on quality of life.
- Individualize management based on symptoms, medical conditions, health risks, family history, treatment goals, and patient preferences.
- Reinforce lifestyle strategies (layering, cooling, stress management, sleep hygiene) and consider guideline-based therapeutic options when appropriate.
Linked guideline: Guideline No. 422a: Menopause: Vasomotor Symptoms, Prescription Therapeutic Agents, Complementary and Alternative Medicine, Nutrition, and Lifestyle
Source: SOGC Menopause Hub
Bone Health:
- Assess fracture risk factors, including history, dietary calcium and vitamin D intake, and physical activity level.
- Reinforce weight-bearing exercise and a calcium-enriched diet with adequate vitamin D supplementation.
- Reinforce smoking cessation and reduced alcohol consumption to prevent early bone loss.
Linked guideline: Guideline No. 422g: Menopause and Osteoporosis
Cardiovascular Health:
- Monitor cardiovascular and metabolic disease risk factors.
- Encourage diet and lifestyle modifications to decrease cardiovascular disease risk.
- Reinforce smoking cessation and reduced alcohol consumption.
Linked guideline:Guideline No. 422e: Menopause and Cardiovascular Disease
Mood, Sleep and Cognition:
- Ask about mood fluctuations, anxiety, sleep quality, memory and concentration concerns.
- Screen for symptoms of anxiety and depression.
- Provide counselling for poor sleep and rule out primary sleep disorders.
- Provide counselling on lifestyle modifications that may help reduce the risk of cognitive decline.
Linked guideline:Guideline No. 422c: Menopause: Mood, Sleep and Cognition
Genitourinary Health:
- Educate about the ongoing impact of estrogen deficiency on urogenital health (such as vaginal dryness, irritation, impaired sexual function, or urinary symptoms [including urinary tract infection]) and the many options available for symptom relief.
- Screen for genitourinary syndrome of menopause (GSM) symptoms such as dryness, dyspareunia, or urinary frequency.
Linked guideline: Guideline No. 422b: Menopause and Genitourinary Health
Sexual Health:
- Include a sexual screening history and physical examination in the initial evaluation, in patients with sexual concerns, as guided by clinical need/discussion.
- Categorize concerns as related to desire, arousal, pain, or orgasm, in order to facilitate treatment and to triage care.
- Advise on vaginal estrogens, lubricants and moisturizers, and pharmacotherapies as treatments for vaginal atrophy related to menopause.
Linked guideline: Guideline No. 422d: Menopause and Sexuality
Lifestyle Modifications:
- Encourage diet and lifestyle modifications to help mitigate menopause-associated disease risk and symptoms.
- Reinforce a calcium-rich diet, vitamin D supplementation, and increased vegetable intake.
- Promote weight-bearing and aerobic exercise, smoking cessation, and reduced alcohol use.
Linked guidelines: Guideline No. 422a: Menopause: Vasomotor Symptoms, Prescription Therapeutic Agents, Complementary and Alternative Medicine, Nutrition, and Lifestyle, Guideline No. 422c: Menopause: Mood, Sleep and Cognition, Guideline No. 422e: Menopause and Cardiovascular Disease, Guideline No. 422g: Menopause and Osteoporosis
Menstrual Cycle:
- Confirm ≥12 months of amenorrhea before diagnosing menopause.
- Any abnormal bleeding patterns or unscheduled bleeding should be investigated.
Source: SOGC Menopause Hub
Bone Health:
- Screen for increased fracture risk by clinical evaluation and bone mineral density assessment.
- Reinforce weight-bearing exercise and a calcium-enriched diet with adequate vitamin D supplementation.
- Encourage smoking cessation and reduced alcohol consumption to prevent early bone loss.
Linked guideline: Guideline No. 422g: Menopause and Osteoporosis
Cardiovascular Health:
- Monitor cardiovascular and metabolic disease risk factors.
- Encourage diet and lifestyle modifications to decrease cardiovascular disease risk where appropriate.
- Encourage smoking cessation and reduced alcohol consumption.
Linked guideline:Guideline No. 422e: Menopause and Cardiovascular Disease
Mood, Sleep and Cognition:
- Ask about mood fluctuations, anxiety, sleep quality, memory and concentration concerns.
- Screen for symptoms of anxiety and depression.
- Provide counselling on sleep hygiene and rule out primary sleep disorders.
- Address ongoing vasomotor symptoms that may be affecting sleep.
- For cognitive concerns, encourage lifestyle modifications and assess for cognitive decline.
Linked guideline:Guideline No. 422c: Menopause: Mood, Sleep and Cognition
Sexual Health:
- Include a sexual screening history and physical examination in the initial evaluation, in patients with sexual concerns, as guided by clinical need/discussion.
- Categorize complaints as related to desire, arousal, pain, or orgasm, in order to facilitate treatment and to triage care.
- Address vaginal atrophy–related symptoms and biopsychosocial contributors.
Linked guideline: Guideline No. 422d: Menopause and Sexuality
Lifestyle Modifications:
- Encourage diet and lifestyle modifications help mitigate postmenopausal disease risk and symptoms.
- Reinforce calcium-rich diet, vitamin D, and increased vegetable intake.
- Promote weight-bearing and aerobic exercise, smoking cessation, reduced alcohol consumption, and fall-prevention behaviours.
Linked guidelines: Guideline No. 422a: Menopause: Vasomotor Symptoms, Prescription Therapeutic Agents, Complementary and Alternative Medicine, Nutrition, and Lifestyle, Guideline No. 422c: Menopause: Mood, Sleep and Cognition, Guideline No. 422e: Menopause and Cardiovascular Disease, Guideline No. 422g: Menopause and Osteoporosis,
Menstrual Cycle:
- Confirm that no scheduled menstrual bleeding is expected.
- Any abnormal bleeding patterns or unscheduled bleeding should be investigated.
Source: SOGC Menopause Hub
Bone Health:
- Screen for increased fracture risk by clinical evaluation, bone mineral density assessment, and assessment of fall risk.
- Continue to reinforce weight-bearing exercise, as well as a calcium-enriched diet with adequate vitamin D supplementation. Encourage smoking cessation and reduced alcohol consumption to prevent early bone loss.
Linked guideline: Guideline No. 422g: Menopause and Osteoporosis
Cardiovascular Health:
- Monitor cardiovascular and metabolic disease risk factors.
- Reinforce diet and lifestyle modifications to decrease cardiovascular disease risk where appropriate.
- Encourage smoking cessation and reduced alcohol consumption.
Linked guideline:Guideline No. 422e: Menopause and Cardiovascular Disease
Mood, Sleep and Cognition:
- Ask about mood fluctuations, anxiety, sleep quality, memory and concentration concerns.
- Screen for symptoms of anxiety and depression.
- Address sleep issues with sleep hygiene education and evaluation for primary sleep disorders.
- For cognitive complaints, encourage lifestyle modifications to decrease the risk of cognitive decline
- Assess for cognitive decline and investigate potential causes
Linked guideline:Guideline No. 422c: Menopause: Mood, Sleep and Cognition
Sexual Health:
- Include a sexual screening history and physical examination in the initial evaluation, in patients with sexual concerns, as guided by clinical need/discussion.
- Categorize complaints as related to desire, arousal, pain, or orgasm, in order to facilitate treatment and to triage care.
Linked guideline: Guideline No. 422d: Menopause and Sexuality
Lifestyle Modifications:
- Reinforce diet and lifestyle modifications to help mitigate postmenopausal disease risk and symptoms.
- Encourage a calcium-rich diet, vitamin D supplementation, and increased vegetable intake.
- Promote weight-bearing and aerobic exercise, smoking cessation, and reduced alcohol use.
Linked guidelines: Guideline No. 422a: Menopause: Vasomotor Symptoms, Prescription Therapeutic Agents, Complementary and Alternative Medicine, Nutrition, and Lifestyle, Guideline No. 422c: Menopause: Mood, Sleep and Cognition, Guideline No. 422e: Menopause and Cardiovascular Disease, Guideline No. 422g: Menopause and Osteoporosis
Menstrual Cycle:
- Recognize that scheduled menstrual bleeding is not expected.
- Investigate any abnormal bleeding patterns or unscheduled bleeding.
Source: SOGC Menopause Hub