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