History

Download an example history form here:

HISTORY FORM.docx

A menopause history should include the following ten sections:

1. Symptoms.
2. Menstrual history.
3. Hormone history and contraception.
4. Medical history.
5. Surgical history.
6. Drug history and allergies.
7. Family history.
8. Lifestyle factors.
9. Engagement with national screening programmes.
10. Identification of patient treatment goals.

1. SYMPTOMS

• Women can usually describe their symptoms; however, some clinicians use a validated menopause symptom questionnaire (MSQ) which can be useful for time keeping and comparison at subsequent visits.
• Health care professionals should ask directly about any genitourinary symptoms or changes to libido. Women may not volunteer this information.
• The frequency, duration and severity of symptoms should be checked along with any impact on life and work.

2. MENSTRUAL HISTORY

• A change in menstrual pattern is inevitable. However, the key factor is to exclude suspected pathology and assess any impact on the woman’s quality of life.
• Post-menopausal bleeding should be referred along a rapid access pathway to gynaecology.
• If amenorrhoea is present, consider the risk of pregnancy.

3. HORMONE HISTORY AND CONTRACEPTION

• Previous or current use of contraception.
• Previous or current use of HRT.
• Fertility treatments.
• Efficacy and tolerability to previous hormone treatments.
• Need for ongoing contraception or any intention to conceive.

4. MEDICAL HISTORY

Check for conditions that may affect the choice and safety of hormone treatments, including:

• Breast cancer, endometrial cancer, ovarian cancer or any hormone receptor positive cancer.
• BRCA or high-risk genes.
• High risk benign breast conditions.
• CVD including history of MI, hypertension, high cholesterol, diabetes, stroke or TIA.
• VTE.
• Migraine.
• Epilepsy.
• Meningioma.
• Liver conditions.
• Thyroid disease.
• Gallstones.

Check for conditions that may suggest an individual is sensitive to hormones, such as:

• Pre-menstrual syndrome.
• Pre-menstrual dysphoric disorder.
• Post-natal depression.
• Puerperal psychosis.
• Progestogen intolerance.

Ask about previous chemotherapy or radiotherapy.

5. SURGICAL HISTORY

• Ask about history of hysterectomy or BSO.
• Where a hysterectomy has been undertaken, identify the indication for this and ascertain whether a subtotal or total hysterectomy was performed.

6. DRUG HISTORY AND ALLERGIES

• Check current medications.
• Check for use of liver enzyme inducers or Lamotrigine.
• Enquire about vitamin D intake.
• Ask about allergies, including to peanuts, almonds and soya (found in some HRT types).

7. FAMILY HISTORY

Enquire about family history, including a history of:

• Premature ovarian insufficiency (POI) or early menopause.
• VTE or thrombophilia.
• Breast cancer, ovarian, endometrial and other patterns of cancers.
• Lynch syndrome.
• High-risk genes such as BRCA1 or BRCA2.
• Osteoporosis.

8. LIFESTYLE FACTORS

• Smoking status.
• Alcohol intake.
• Exercise.
• Diet including vegan history.
• Occupation and stress levels.
• Support.

9. ENGAGEMENT WITH NATIONAL SCREENING PROGRAMMES

• Date and result of last cervical smear.
• Date and result of last mammogram if applicable.

10. IDENTIFY PATIENT’S TREATMENT GOALS

• Non-pharmacological options.
• Non-hormonal options.
• HRT.