The questions answered in this podcast are listed below.
They were compiled by GPs and health professionals around Australia.

1. What are the risks posed by cardiovascular disease when you’re considering menopausal management?
2. What do you consider high risk cardiovascular disease? For example, if a woman has a strong family history of heart disease but a zero-calcium score.
3. Does the use of menopausal hormone therapy reduce the risk of cardiovascular disease and death?
4. Can you diagnose menopause in a woman with amenorrhea, or very irregular periods by doing a progesterone challenge test. Any tips on how to diagnose?
5. Is a persistent high temperature, greater than 39 degrees a vasomotor symptom, because they’re suggesting that thermoregulation might be affected?
6. Are you aware of any evidence on cannabidiol oil in treating menopausal symptoms?
7. Can androgen deficiency cause hot flashes, fatigue or their mood?
8. Could you provide more information on where patients can find evidence supporting the use of cognitive behavioural therapy for managing vasomotor symptoms? Additionally, it would be helpful to know if there are online services available that patients can access for this treatment?
9. How can you best treat brain fog?
10. Is it reasonable to use different pharmacological agents that target specific symptoms, such as urinary urgency or hot flashes, before considering hormonal treatments? Is this an appropriate approach to managing symptoms?
11. What indicators would there be for treating a woman with Vulvovaginal syndrome of menopause with something like Intrarosa dehydroepiandrosterone (DHEA) instead of Avastin or Estradiol tablets?
12. Would you recommend or suggest starting local oestrogen creams for a patient above 60-years-old for atrophic, vaginitis or dryness?
13. Is there any upper limit? How long can you safely use these vaginal preparations?
14. Can you cut hormone patches when you’re weaning someone off menopausal hormone therapy or when the patient just can’t obtain the right dose. Is it okay to cut the patches (i.e in half, or thirds)?
15. Why should paroxetine be avoided for the treatment of hot flushes in tamoxifen users and is there anything else we should be avoiding in these patients?
16. Are there any effective treatments for a woman who presents between late 60-70 years old for management of hot flushes that have come back after settling and, should we be using menopause hormone therapy or starting them on non-hormonal therapy?
17. Patient case: I’ve got a patient classed as BI-RADS D who’s currently on menopausal hormone therapy. How should we monitor her?
18. Patient Case: I have a few patients who are starting ashwagandha based on information from social media and blogs. Are there any research studies on its effectiveness? What exactly is ashwagandha, and is it beneficial for managing menopause symptoms? Additionally, are there any potential risks associated with its use?
19. Is there any feedback, data or experiences supporting the efficacy of happy mammoth supplement?
20. Selective serotonin reuptake inhibitors (SSRIs) can sometimes cause sweating as a side effect and is this ever an issue when you’re trying to use it for hot flushes?
21. Does Mirtazapine have a role in the management of vasomotor symptoms?
22. Could you please discuss the use of Prometrium per vaginally and the recommended doses when you give it by that route?
23. If you’re on a standard or higher dose of something like Estraderm, is there a need to increase the Prometrium dosing on the higher dose? Do you need to give double the dose or give it more often?
24. Can you please clarify the role of Tibolone in menopause, including its relative benefits and risks?
25. I’m having trouble with resistance of some of my patients to start menopause or hormone therapy due to being told by their breast physician, surgeon, and friends that no woman with even a moderately increased risk of breast cancer should ever be on menopause hormone. How would you recommend that we advise these patients?
26. Patient Case: I’ve got a 40-years-old who’s perimenopausal and presents with hot flushes, mood swings, night sweats and brain fog. She has a history of Churg-Strauss syndrome. What is the best option for her treatment?
27. Patient Case: I see lots of perimenopausal patients who have already started menopause hormone therapy and have irregular periods. However, on menopausal hormone therapy they get regular periods and they feel better, do they need contraception advice? Do you need to use contraception if you’re on menopausal hormone therapy?

Expert: Prof Rod Baber, Obstetrician and Gynaecologist

Host: Dr Terri Foran, GP and Medical Educator

Total time: 38 mins

Recommended resources:

• CBT-T | University of Sheffield
• Centre for Clinical Interventions | Government of Western Australia
• Online CBT | Australian Association for Cognitive and Behaviour Therapy
• moodgym
• This way up
• Beyond Blue
• Australasian Menopause Society
• Jean Hailes for Women’s Health
• Australian Cardiovascular Risk Calculator