Menopause

OVERALL_INSTRUCTIONS

Chief Complaint

Perimenopausal symptoms

specialty

Endocrinology

tags

Template

Thank you for referring [name], a [age] year old [gender], who was seen on [date] for assessment of perimenopausal symptoms. Consent: I obtained consent from the patient for use of an AI scribe software. I explained that Empathia saves a copy of our conversation on their website for the purpose of generating a note, and that this software is FDA approved. History of presenting illness: [Brief description of when the patient's symptoms, when they were initially discovered, and initial testing done] Last menstrual period: Changes to menstrual cycle: Vasomotor symptoms: [present or absent] Sexual dysfunction: [present or absent] Urinary symptoms: [present or absent] Mood issues: [present or absent] MSK symptoms: [present or absent] Severity of symptoms: [mild, moderate, or severe] CAD: [present or absent] Bone fractures: [present or absent] Breast, endometrial, or ovarian cancer: [present or absent or prior] VTE: [present or absent or prior] Migraines: [present or absent] Stressors: [present or absent, and description of stress] Past medical history: [medical_history] (List numerically with each having its own line) Medications: [drug_name] (List numerically with each having its own line) Allergies: [allergies] (List numerically with each having its own line) Social history: Exercise: [exercise] Meals: [meals] Work: [work] Extended coverage: [coverage] Alcohol: [alcohol] Cigarettes: [cigarettes] Drugs: [drugs] Family history: [family_history] [Family history of breast cancer, VTE, or other malignancies] Exam: [general exam, weight, height, vitals, cardiac exam, pulmonary exam] Weight: Height: Blood pressure: Heart rate: Thyroid: [normal size and consistency, no palpable nodules, no tenderness, mobile with swallowing, and no cervical lymphadenopathy] [No signs of acromegaly or Cushing's syndrome] [No signs of Turner's syndrome] [No excess hair growth on the face, upper chest, abdomen, or arms]] Investigations: [investigations] (Organize lab values by date and list each lab value on its own line) Impression and Plan: [name] is a [age] year old [gender] with [symptoms of menopause or menopause]. Contraindications to menopausal hormonal therapy include: estrogen dependent cancers, unexplained vaginal bleeding, pregnancy, coronary heart disease, stroke or VTE, acute liver disease, personal history or high risk of thromboembolic disease, and porphyria 1. [Perimenopause/menopause]: (List detailed action plans using the correct person tone, e.g., '- I have started [medication] for [condition] control' or '- The family doctor has initiated...)' [- I have provided the patient with bloodwork to confirm menopause and assess for secondary causes of amenorrhea, including day 3 FSH, LH, bhCG, prolactin, TSH, free T4, AM cortisol, IGF-1, total/ bioavailable/free testosterone, 17-OHP, DHEAS/androstenedione, liver panel, Cr/eGFR, CBC] [- If the lab findings do not suggest menopause, then I will pursue a pelvic US to assess the endometrium lining and consider a progesterone challenge] [- I discussed menopausal hormone therapy options with the patient, including ] [- Additional agents include SSRI/SNRI, gabapentin, and clonidine] [- In women who are unable to tolerate or have contraindications to estrogen, fezolinetant is an option] [- I have requested a BMD to assess for osteoporosis] [- I have initiated low dose testosterone supplementation of testosterone 25mg IM qweekly for hypoactive sexual desire disorder] [- Given her early menopause (age 40 to 45) or premature ovarian insufficiency (prior to age 40), I have provided screening for Turner syndrome and Fragile X premutation. POI is associated with increased risk of metabolic syndrome, osteoporosis, and malignancy] 2. Non-pharmacologic management: - I have recommended that the patient avoid excessive caffeine and alcohol, and to achieve sufficient exercise of 150 minutes of moderate to intense activity per week - I have counselled the patient on the effects of stress on vasomotor symptoms, and to minimize stressors if possible 3. Follow-up: I have arranged for follow-up in [1 month/3 months/6 months] Patient Counseling: I counseled the patient on the side effects of hormone replacement therapy, including increased risk of VTE (by approximately 3x, or 2 extra cases per 10 000 women-years), breast cancer (especially with the addition of progesterone), ischemic stroke (by approximately 1.5x), gallstones (by 2x), migraines, and liver disease. Thank you for involving me in the care of this pleasant patient. Please do not hesitate to contact me with any questions or concerns. Dr. Leo Hu, MD, FRCPC Elida Medical Centre