13 May Menopause: change is needed to enable better care
Managing menopausal women with Hormone Replacement Therapy (HRT) is definitely the most rewarding part of my job as a doctor. It is lovely when I hear women tell me that the HRT has given them their life back, that their energy has returned, that their relationships with their partners and their children has improved.
The vasomotor symptoms of menopause are the ones that are most obvious when thinking about the condition but these are not the symptoms that affects patient safety the most. It is the symptoms of low mood, anxiety, low self-esteem, poor memory and concentration, no libido and vaginal dryness that affect women the most.
There is now overwhelming evidence that HRT is effective in reducing both future cardiovascular disease and osteoporosis, when given within ten years of menopause1,2. These are both very important and significant conditions that affects many women in the UK. There are now excellent and comprehensive national and international guidelines available for the management of menopause which we should be working from3,4,5.
Raising awareness is key
Despite this, I frequently hear stories from my patients about how they are refused HRT from their GPs. Some are told that menopause is simply part of their life and they need to “get on with it”, others are told that HRT is too expensive, others are given inaccurate information, for example that they have to be postmenopausal to take HRT.
Many patients tell me that their doctors look up HRT in the BNF (British National Formulary) and are not confident what dose and type of HRT they should be prescribing. Perhaps more worryingly and commonly, the majority of women that come to see me in my menopause clinic have been inappropriately given antidepressants for their symptoms of low mood associated with menopause.
A recent survey I undertook showed that around three quarters of women have had insignificant information from their GPs. When I give lectures to GPs, only a handful admit to being confident in diagnosing and managing women with early menopause. I find this very worrying especially as one in a hundred women under the age of 40 in the UK will have Premature Ovarian Insufficiency (POI)6. Women tell me that they have been told that they’re too young to be menopausal and their symptoms are simply dismissed. Not treating these women is exposing them to a far greater risk of cardiovascular disease, osteoporosis and cognitive problems in the future and refusing treatment is going against all current guidelines.
Although menopause is not a disease, I feel that a consultation about menopause should be seen as an “opportunity”. This is because correct medical intervention and advice at this point of life can offer women years of benefits from preventive health care.
Change is needed to support patients
There is still considerable confusion about HRT and this needs to change. Much of the confusion has arisen from inaccurate media reporting of large studies, which has resulted in too many women not receiving HRT and as such living with dreadful symptoms.
Over the past few months I have been working closely with West Midlands Police and the Fire Brigade helping their menopausal women at work. A recent questionnaire undertaken by West Midlands Police has shown that over 80% of women had symptoms which affected them at work. Perhaps more concerning was that 77% of women did not realise their symptoms were even due to menopause until they had been given information about it.
As we are all working for longer and retirement age is increasing, there has never been a better time for companies to help menopausal women at work. Recent Faculty of Occupational Medicine guidelines have been produced and companies need to engage with these7.
I feel very passionate about helping menopausal women – they need clear advice which is based on sound evidence and current guidelines. I am trying to help empower healthcare professionals with more knowledge and experience to correctly manage menopause so women don’t have to have their lives ruined by their symptoms and can be offered a treatment that can also invest in their future health.
I cannot honestly think of any other guidelines that are ignored as much as the NICE guidelines on the diagnosis and management of menopause. This has to change!
Dr Louise R Newson BSc(Hons) MBChB(Hons) MRCP FRCGP qualified from Manchester University and is a GP in Solihull, West Midlands, as well as a writer for numerous medical publications. She compiles and updates information leaflets for the award winning website Patient.info.
Louise works as a medical editor for different publications and has authored several books on evidence-based medicine for GPs. She is an editor for the British Journal of Family Medicine (BJFM). She is an Editor and Reviewer for various e-learning courses and educational modules for the RCGP. She writes regular articles for GPonline.com, MIMS Learning and www.OnMedica.net.
She has a keen interest in menopause and HRT. She feels passionately about trying to improve awareness of safe prescribing of HRT to healthcare professionals and women and has written many articles, editorials and given local and national presentations on this subject. She is the West Midlands lead for the Primary Care Women’s Health Forum (www.pcwhf.co.uk). She runs a menopause clinic in Solihull and is a member of the International Menopause Society and the British Menopause Society. She has recently developed a new website www.menopausedoctor.co.uk. Louise works regularly with West Midlands Police and Fire Brigade to provide advice and support regarding menopause in the workplace.
1. Lobo RA, Pickar JH, Stevenson JC, Mack WJ, Hodis HN. Back to the future: Hormone replacement therapy as part of a prevention strategy for women at the onset of menopause. Atherosclerosis. 2016 Nov;254:282-290
2. Zhu L, Jiang X, Sun Y, Shu W. Effect of hormone therapy on the risk of bone fractures: a systematic review and meta-analysis of randomized controlled trials. Menopause. 2016 Apr;23(4):461-70.
3. NICE. NG23. Menopause: diagnosis and management. November 2015
4. The British Menopause Society & Women’s Health Concern 2016 recommendations on hormone replacement therapy in menopausal women. H Hamoda, N Panay, R Arya, M Savvas, on behalf of The British Menopause Society and Women’s Health Concern. Post Reprodcutve Health December 1, 2016; pp. 165–183
5. R. J. Baber, N. Panay & A. Fenton the IMS Writing Group (2016) 2016 IMS
Recommendations on women’s midlife health and menopause hormone therapy, Climacteric, 19:2, 109-150
6. Hamoda H; British Menopause Society and Women’s Health Concern. The British Menopause Society and Women’s Health Concern recommendations on the management of women with premature ovarian insufficiency. Post Reprod Health. 2017 Mar;23(1):22-35