Guidance for PCPs: Streamlining Menopause Care

EP: 1.Overview of KNDy neurons

EP: 2.VMS Symptoms and Neurokinin Receptor Antagonists

EP: 3.Neurokinin and Estrogen Balance in Menopausal Hot Flashes for Primary Care

EP: 4.Fezolinetant Guidelines and Emerging Data on Menopause and Liver Health

EP: 5.Molecular Comparison and Safety Profiles of Fezolinetant and Elinzanetant

EP: 6.Malignancy Risks of Neurokinin Receptor Antagonists

EP: 7.VMS Treatment Guidelines

EP: 8.Nonestrogen Treatments for Menopause

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EP: 9.Guidance for PCPs: Streamlining Menopause Care

Episode 9

The following transcript has been edited for clarity, style, and length.

Mary Jane Minkin, MD: For our practitioners watching today, thank you for taking the time to view this discussion. There’s a lot of complex information here, and our goal is to clarify it as much as possible. A common challenge is streamlining these conversations with patients, as spending hours with each patient isn’t practical. Lisa, what strategies would you suggest for busy practitioners to streamline these discussions?

Lisa Larkin, MD: For my colleagues in internal medicine, family medicine, and primary care, I’d first like to emphasize the importance of asking your midlife patients about vasomotor symptoms. The menopause transition is a critical time to assess cardiovascular risk and focus on long-term health and wellness. Women experiencing vasomotor symptoms are at increased cardiovascular risk, so it’s much more than a lifestyle issue.

Remember that the U.S. Preventive Services Task Force is clear: hormone therapy isn’t indicated for primary prevention. However, that’s different from addressing the symptomatic menopausal patient in front of you who may not be sleeping, is experiencing sexual dysfunction, and is generally miserable.

I suggest a “red, yellow, green” approach to categorize patients:

1. Green patients: These are women who are symptomatic with moderate to severe vasomotor symptoms, are close to menopause (within 10 years of their final menstrual period), and have no significant cardiovascular risk factors, clotting history, or elevated breast cancer risk. For example, the 52-year-old sitting in front of you who is miserable but otherwise healthy—she’s a great candidate for menopausal hormone therapy.
2. Red patients: These are women with clear contraindications to hormone therapy, such as a history of breast cancer, thromboembolic events, high cardiovascular risk, or prior cardiovascular events like a stroke. For these patients, focus on non-hormonal options, such as fezolinetant or, if approved, elinzanetant, along with other off-label non-hormonal treatments.
3. Yellow patients: These are the intermediate cases. These women may have some risk factors that require a more nuanced discussion and consideration of patient preferences. If this isn’t your area of expertise, consider referring these patients to a provider specializing in menopausal medicine.

Using this framework can help streamline your approach and build confidence in using FDA-approved non-hormonal options for patients who cannot or will not use hormone therapy.

Minkin: Exactly. For those “yellow category” patients who don’t have clear indications for or against hormone therapy, it’s essential to connect with specialists in your area for guidance. If you’re unsure who those people are, I strongly recommend visiting Menopause.org, the website of the Menopause Society. They provide a directory of certified menopause practitioners who are well-versed in this area and can assist with patient care.

And if you’re looking to deepen your knowledge, I encourage you to join the Menopause Society. Attend our annual meeting or the Menopause 101 course to learn more and enhance your ability to support these patients.

Larkin: Yes, becoming a member of the Menopause Society is an excellent way to stay current and build expertise in this critical area of patient care.

Minkin: Thank you for watching this Patient Care Primary View. We hope you’ve found this discussion valuable!