Delivery of diagnosis of early menopause and emotional impact: Health Practitioners’ perspectives

The diagnosis of early menopause (EM) is usually delivered by a general practitioner (GP) or specialist such as a gynaecologist or endocrinologist (see Referrals and coordination of care for early menopause), following blood tests to measure hormone levels and often an ultrasound to look at the ovaries and uterus (see Tests and challenges in the diagnosis of spontaneous early menopause).

Being diagnosed with EM can be a distressing experience for women, particularly if it is unexpected. Health practitioners emphasised the importance of sensitivity and described choosing their words carefully when explaining the diagnosis to women.

Dr Ee, a GP, shared her approach to delivering an EM diagnosis, and explained how she refers patients to specialists to confirm the diagnosis. 

Although some health practitioners preferred to be cautious with their choice of words when explaining the diagnosis, others, such as Dr C, an obstetrician-gynaecologist, favoured a more direct approach: ‘People like to hear the information straight up because they like to look it up too’.

Finding out about the implications of the diagnosis can also be difficult for women, particularly in relation to long-term health effects such as osteoporosis (see Long-term health effects of early menopause), and fertility loss (see Fertility and early menopause).

Dr Goeltom, a GP, explained the importance of speaking to women about the long-term health implications of early menopause. 

For women wanting to have children, fertility loss can be a ‘traumatic’ aspect of the diagnosis of EM (see Fertility and early menopause). Some health practitioners expressed the view that (with the exception of EM following oophorectomy) diagnosis should follow repeated tests over months of monitoring, because, as Dr C said: ‘it’s dangerous to tell anyone that they’re completely infertile unless either we’ve proven it over a very long amount of time, or their ovaries have been removed’.

Dr K, a fertility specialist, outlined her approach to delivering diagnosis and discussing fertility options with patients. 

Several health practitioners spoke of the need not to overwhelm women with information and where possible ‘stage’ conversations on diagnosis and implications. As Dr D, an endocrinologist, said: ‘it’s a matter of saying, “I’m here, I’m going to do all the right stuff … But it’s going to be a delayed process, and there’s going to be several steps”’.

For women who experience EM as a result of cancer treatment, the focus of initial consultations is often primarily on cancer, with conversations about menopause symptoms occurring later. Ms Lewis, a breast care nurse, explained: ‘the doctors will talk to [women] in more detail once they prescribe the [endocrine therapy ] tablet, but they don’t go into detail earlier on. I think that’s because they feel that the patient has got enough to cope with … One step at a time and you can get people through. If you throw too much information at them too soon then you just confuse them’.

Obstetrician-gynaecologist Dr Baber described his approach to informing patients of the implications of spontaneous early menopause in separate consultations.

The emotional impact of the diagnosis can vary depending on the cause of EM; if it is spontaneous, related to cancer or other medical treatment (see Telling women that cancer or medical treatment may cause early menopause), or due to genetic disorders such as Turner Syndrome. Cases of spontaneous EM with no known cause (idiopathic EM) can be particularly distressing. As Dr D explained: ‘I think the worst thing is when there’s absolutely no cause and nothing that they can put their hand on because they feel very vulnerable – ‘Why did this happen to me?’ And to have a reason or a cause is very important for some women’.

Dr Goeltom, a general practitioner, explained that patients’ reactions to an EM diagnosis can differ depending on the underlying cause.

Some health practitioners also observed that the emotional impact of a diagnosis of EM was dependent on a woman’s particular circumstances, and emphasised the importance of asking women what the diagnosis meant to them.

General practitioner Dr Ee shared her experience with a patient who had a ‘very positive’ reaction to being diagnosed with EM.

Further information

Talking Points (Health Practitioners)

Talking Points (Women)

Other Resources