Position Statements

Affordable post-menopausal care

All health workers should be trained in appropriate counselling and management of menopausal problems. Menopausal care is a national priority and the benefits of hormone replacement therapy are widely acknowledged. Life style adaptations may play an important role in post menopausal care, and patients should be encouraged to take part in the decision making process.

SASOG supports the concept that decisions regarding therapy should be case-specific and based on individual considerations of risks and benefits for every option. The benefits of hormone replacement therapy should be available for all women who may benefit from that. This must include the "hospital patients" who frequently are not offered the option of hormone replacement therapy, or who face a decreasing list of treatment options in an ill-advised drive to rationalise treatment available.

Postmenopausal care extends beyond simply hormone replacement therapy. A sub-group of women will require different therapeutic approaches to osteoporosis and for cardiovascular health.

Preventive diagnostic testing (bone densitometry and mammography) plays an important role in postmenopausal care, but both tests have the potential for over-utilisation. SASOG is in support of selectively performed densitometry after careful assessment of predisposed individuals. Mammography in the postmenopausal patient has a definite role to play but the frequency of testing should be carefully determined in at risk patients. Practitioners should realise that all tests have limitations in sensitivity, specificity and therefore predictive values.

Health workers should use every opportunity to inform and educate the public and communities on the menopause, life style adaptations, treatment options as well as potential complications.

Prepared by Dr Errol Goeller, Dr Tobie de Villiers and Prof Zephne van der Spuy.
Edited by Prof Gerhard Lindeque.
August 2001