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Menopause

Advice to health professionals about the menopause

For many women the menopause transition can bring confusion and uncertainties. Getting the right advice from health professionals is crucial. Some women were happy with the advice and service they received, others worried that the menopause is being overlooked. Several women felt that, as older women, they were ‘invisible, with very little voice’ (see ‘Getting older’).

 

Judy talks about the lack of services for menopausal women in her GP practice

Judy talks about the lack of services for menopausal women in her GP practice

Age at interview: 46
Sex: Female
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Well for instance when I went for my flu jab there’s the main waiting room for the doctors and all of the posters up there are about flu jabs and about NCT [National Childbirth Trust] for childbirth and there was nothing for menopausal women. Whereas when I went round the side into a little closed corridor where the nurses’ offices are, where you go just for the jabs, there’s a tiny word processed poster advertising a menopausal discussion group. And just by the mere act of downplaying it onto just a word processed page and sticking it on the wall out of the way, makes you feel as though this is something that the GP’s surgery doesn’t consider to be a priority. It’s not something they want to recruit loads of women to. It’s not a service they want to push. And therefore if I was to say I’m interested in it, what sort of service would I receive, what other women would go for it and how would I be viewed by the healthcare professionals? It just didn’t send me the message that the changes that I’m going through are important enough for the surgery to take forward and so it didn’t entice me at all.

How do you feel about that?

I feel that they’re missing a picture. I think that for me I’m okay, I’ve got a supportive husband, I can do research on it if I want, I’ve got support groups amongst friends if I choose to pursue that but for other women this may not be the case. And I think it’s a service - I mean fifty per cent of the population are women, a hundred per cent of them are going to go through the menopause at some point. There’s nothing on the T.V. about the menopause. It’s something that society just pushes out of the way and it’s a reflection of the value that they place on older people in general and women in particular. And it’s a very important issue to deal with. I would imagine that for some women it can lead to significant levels of depression. The change in how you perceive yourself, how society perceives you and also the hormonal changes in themselves may engender some sort of endogenous type of depression and depression amongst the elderly is a significant issue for PCTs [Primary Care Trusts] so I think it’s an area which is very overlooked and should be addressed.

So what sort of information do you feel they should be providing and what sort of services do you think would be helpful?

I think they have to normalise it first and say every woman will go through the menopause at some point, that this is perfectly natural, it’s nothing to be frightened about, it opens up new opportunities rather than it is a loss of a particular phase but it’s an opening up of new ones and to put it across in a much more positive and upbeat way rather than a little grey poster on a wall saying “do you want to talk about your menopausal experiences?”. I think a support network is appropriate where you can meet people that you don’t necessarily have a friendship with but you’re just there because you’re menopausal and that in itself is self limiting in how you feel you’ll be perceived. You go along because you want to be perceived as a menopausal person but with your friends you don’t want to be necessarily seen as that. So that sort of peer group support is appropriate but with informed input from the professionals who know about this and if there are particular health issues which are arising as a consequence of the menopause then those can be identified and dealt with appropriately.

 

Dr Sally Hope explains why the menopause has become ‘a Cinderella subject’ in general practice

Dr Sally Hope explains why the menopause has become ‘a Cinderella subject’ in general practice

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I think there are a number of issues. Firstly, in general practice we’re so focused on government targets, which we have to do. The government is pelting us with targets on things like cardio-vascular disease, diabetes, asthma, cancer, mental health that menopause is a Cinderella subject. We get no payment for doing it and so a lot of GPs have it as an extraordinarily low priority and really I happen to have an interest in it both personally, because I’m going through the menopause and I’ve been working in this area for twenty years. So I have that knowledge base, which I’ve found personally very helpful to keep me on a even keel but I think most GPs, to be honest, don’t have the time, don’t have the interest, don’t have the information in their minds about all this. And often I find women coming in who’ve read some excellent websites or books are actually much better informed than the average GP and that’s nice because you educate us as you come into the surgery. But quite often we don’t support women very well.

To remedy this, women believed that their GP practice could provide a more comprehensive service to support them through the menopause. As well as up-to-date leaflets in the waiting room, they wanted time to talk to their GP face-to-face; dedicated menopause practitioners and clinics; and opportunities to share experiences with other women.

1. Time to talk face-to-face with GPs
Women value the opportunity to talk to their doctor face-to-face. They want in-depth advice and support and also greater access to medical expertise. While acknowledging that time is limited, they want GPs to listen, be sympathetic and adopt more of a counselling role rather than simply dismissing the menopause as ‘all part of your life journey’. They described a good GP as one who ‘tunes into the difficulties’ women are trying to get across and accepts that even though the menopause ‘isn’t going to kill us’ it can be debilitating (see ‘Consulting the doctor’). Women want their GP to ‘be experienced and really knowledgeable’ about HRT and to guide them through the conflicting evidence and the ‘forest of newspaper scares about HRT’ so that they can make an informed decision about treatment options (see ‘Hormone replacement therapy (HRT)’).

 

Carole compares her experience with two GPs. She stresses the importance of doctors listening and...

Carole compares her experience with two GPs. She stresses the importance of doctors listening and...

Age at interview: 51
Sex: Female
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Well I suppose I’ve seen both sides of the coin haven’t I. I’ve had the experience with the first lady doctor who made me feel very stupid and made me feel like I was wasting her time by going and that is not on.

But you just have to have choices and when you’re menopausal and going through the menopause it’s very easy to let your choices go. It’s very easy to be led by doctors and nurses and friends as well who let you down. I just feel that the medical profession needs to have a broader view of things because every woman’s menopause is different and it affects them in a very different way. It takes over their life and it’s there day in day out and it’s a pain in the butt. But it’s going to stay with you for a long time. And it was so refreshing to see this second doctor, I mean she listened, she asked questions, and she advised and she made suggestions and it just gives you hope. Rather than having the door slammed in your face saying one of two things, you’re depressed or it’s the menopause get on with it.

 

Barbara urges GPs to treat each case individually

Barbara urges GPs to treat each case individually

Age at interview: 52
Sex: Female
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I think the important thing is that every woman is an individual and you can’t say “Oh well, the last ten that I’ve seen this has worked for” you’ve got to treat each individual case differently. Listen to what the woman’s saying because nine times out of ten that woman’s already gone and looked it up for herself, she’s gone to the doctor because she’s getting at the end of her tether and she realises that she’s got to go and talk to somebody that’s supposed to be a professional and knows about these symptoms. And I think sometimes they don’t, they don’t have enough patience with you, they don’t sit and listen to you and perhaps give you a bit of sympathy. Because sometimes it’s just the woman wants to talk and just talking to somebody.

 

Dr Sally Hope’s patients want reassurance that they’re ‘not going mad’

Dr Sally Hope’s patients want reassurance that they’re ‘not going mad’

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What do you think women need?

I think they need access to information to reassure themselves that they’re not going mad, that it’s self-limiting and it will get better. Because I think women put up with everything all through their lives and they just want to know, “Is this normal? Am I in the realms of normality because I’ve never felt like this before.”

People often come in, sit down in my surgery and say, “I think I’m going mad.” Or, “I’m worried I’m going demented like my mother did.” And actually that reassurance of, “No, you’re not mad. You’re not abnormal. This is the menopause. It will get better.” Is all women want and then they’ll get on with running Marks & Spencer, looking after their husbands and everything else that we do all the time.

Women suggested that doctors start discussions about the menopause and not wait until patients come with debilitating symptoms. One woman recommended ‘a health check round about fifty’ where doctors could ask about symptoms; another, who admitted she ‘knew nothing about the menopause’, proposed that women be sent literature and invited to ‘come in and talk about it’ before they reached the menopause.
 

Rebecca believes that doctors should raise the subject of the menopause and discuss it when women...

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Rebecca believes that doctors should raise the subject of the menopause and discuss it when women...

Age at interview: 57
Sex: Female
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I think it would be a good idea that a woman of a certain age could be asked when they’re in, no matter what they’re in for, just ask about the menopause. Have you noticed it? Where are you at with it? How are your periods? What are the symptoms? Maybe to gather up information or at least to create awareness. And then I suppose for health professionals to be aware themselves as well, to be up to date on what’s happening around it sort of thing.

Maybe things like say the vaginal dryness, is there anything that they would recommend that you could take. Around HRT I would like them to have the inside knowledge, I would like them to be well-experienced and be really knowledgeable about it as well so that they could give me all of the information that I need to make a decision sort of thing. I think I would also like them to be proactive rather than reactive when women come into the surgery.

So I think that’s probably the things and then when people come in with other symptoms, with symptoms of something else that they could check out to see maybe is it the menopause?


2. Up-to-date leaflets and information
Rather than just doing their own research, women want to be directed to reliable information, resources and websites about the menopause As well as information on HRT, they want leaflets which explain ‘what’s normal and what isn’t’, and advice on complementary therapies and diet and exercise (see ‘Complementary therapies’, ‘Non-HRT and lifestyle options’ and ‘Changes in the body and keeping healthy’). Leaflets in doctors’ surgeries alone, however, are not enough. One woman complained that, being dyslexic, she couldn’t read the leaflets. Another wanted ‘more than a five minute appointment’ so that she could go over in detail what she’d read and ask questions (see ‘Sources of information’)
 

Marcia says that literature would help ‘at an early stage’

Marcia says that literature would help ‘at an early stage’

Age at interview: 46
Sex: Female
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I think if they’ve got any literature they should really be giving you the literature at an early stage so like when I went and said that my periods were starting slowing down and stopping that if I’d had information about what this might be. So that you could say you might be going through your menopause, these are the symptoms to look out for, and then talk about the different sorts of treatments like what is HRT, so that you know what it is so that you can actually kind of plan your menopause in a sense.

 

Margaret feels that pharmacists are an ‘underused resource’ for information about the menopause

Margaret feels that pharmacists are an ‘underused resource’ for information about the menopause

Age at interview: 59
Sex: Female
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And the NHS is not structurally, it’s not possible under the NHS to get the right information to everybody when they need it. It’s just logistically almost impossible. I think the one place where it would be really, really useful to get the information would be from a pharmacist. I think pharmacists are a very underused resource. They have a vested interest in making sure that their customers have the information that they want, they get the drugs that they want. They’re a very accessible place to go because if you go into the surgery you’re going to run into various neighbours because you live in a small community and people are going to see you and they’re going to say, “Oh, she’s in the surgery. I hope she’s all right. I wonder what she’s in for.” Go into Boots. You’re going to buy a shampoo, you’re going to buy foundation and you’re going to go and talk to somebody about menopause. It’s just a more accessible resource. I’ve thought for ages actually that pharmacists are very well trained, very highly trained. And I would like there to be more. Even little consultation rooms, little cupboards where you could go and just say, “I’ve been on this HRT for about three years. I really don’t think it quite suits me. Is there something else I could get?” I’m not suggesting they take over from doctors but they could say, “Yes, there’s this kind and these side effects and those side effects and those side side effects. Have a look through that and then go and see your GP and he might be able to prescribe something else.” It takes less time from the GP and makes it easier for the person too.


3. Dedicated menopause practitioners
Women recognise that listening to their needs, showing empathy, answering questions, giving information and discussing a range of treatment options may not always fit into a five or ten minute GP consultation. Despite good intentions, GPs and practice nurses can find it hard to deliver the type of specialised care women seek during the menopause, especially when guidelines and targets prioritise other aspects of health care.

Women suggested the need for dedicated practitioners in each practice who have training in the menopause and can advise women. They want doctors who are ‘very interested in female health’, willing to give them time, and prepared to refer them to a consultant or counsellor if necessary. Some women would like to see a menopause clinic set up in their practice, along similar lines to clinics for asthma and diabetes, where women can talk about their symptoms and concerns and get expert advice.
 

Joyce highlights the need for a specialised service for menopausal women

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Joyce highlights the need for a specialised service for menopausal women

Age at interview: 48
Sex: Female
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I suppose what seems strange to me is that we have clinics for diabetes, we have clinics for family planning and contraception, we have clinics for pre-natal and post-natal, we ought to be having some clinics really shouldn’t we for, because every woman’s going to go through it, fifty one per cent of the population’s going to face this challenge.

Do you mean clinics within the GP structure within primary care?

I suppose so, or somewhere where you can go, where people specialise in this and you can get the very best advice. I mean when I had a slipped disc I went to an orthopaedic surgeon who specialises in keyhole surgery who could see this is pretty critical to you as a human being so we’ll get you the best possible care. When I had a problem with my face, with my skin, I went to a dermatologist. I’ve got a problem with coping with life through the menopause but I see the GP who does everything. I’ve now seen three different doctors all of whom are general practitioners for advice and I’ve got nothing negative to say about the service I’ve got. But I haven’t gone somewhere where they’ve said, “Okay, well let’s sit down and talk about the various options, natural remedies might be right for somebody in the early stages, but she didn’t even know what the natural remedy I was taking, which is in a healthcare magazine, is even or what would the impact do. I’m not critical of the support I’ve had because it’s been brilliant in terms of a purely medical perspective. But I just wonder whether there’s the opportunity to give something that’s a little bit more holistic if you had healthcare professionals and it doesn’t just need to be doctors does it? But if you had healthcare professionals who were able to signpost you to a whole range of options and remedies for the whole range of symptoms and issues, I guess it would help you to make a more informed choice about how to deal with the issue.


4. Opportunities to share experiences with other women
Some women felt it would be helpful to have opportunities to share experiences of the menopause with other women at their GP surgery. Their suggestions included a support network ‘with informed input from the professionals’; a drop-in centre staffed by a ‘dedicated nurse or trained person’, with a waiting area where women can ‘have coffee and a chat to other women’; and counselling groups focusing on the emotional and mental aspects of the menopause.
 

Charlotte believes there is scope in her health care centre for a well-woman clinic dedicated to...

Charlotte believes there is scope in her health care centre for a well-woman clinic dedicated to...

Age at interview: 54
Sex: Female
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My sense is that a lot of us just don’t understand the process that we’re in and we’ve all got a lot of questions and they might seem small naive little questions but they need to be answered. And because you feel the GP’s time is so limited I would have welcomed I think an opportunity to be referred to the specialist nurse just to talk to her. In fact I prefer talking to women so if the GP had said “do you want some advice on menopause, do you want some discussion about it, have you got any questions? Well you might like to make an appointment with the nurse”, then, and I’m assuming a gender thing here which I probably shouldn’t assume, but probably our experiences guided me there. But an opportunity like that would have been good. I notice that in my healthcare centre there are other sessions available on other conditions where there is some nurse intervention or some small group are brought together. I think that might be valuable. At one time the Family Planning Clinic acted like a kind of Well Woman Clinic in [place]. I don’t know if that provision is elsewhere. But it’s since changed because of lack of resources and everything it’s mainly about contraception now but that model that you could make an appointment and go to a session where there were women who were having advice on contraception and general healthcare, that would have been great.

One woman believed more people would be encouraged to attend support groups if meetings ‘lost their clinical aspect’ and became more social ‘like mother and toddler groups’. Another wondered whether meetings in a community venue such as the village hall might be a better option but was unsure whether women would attend. With the majority of women working, one woman stressed the need for evening meetings but doubted that health professionals would participate (see ‘Support networks’ and ‘Work’).
 

Denise outlines the pros and cons of a menopause clinic

Denise outlines the pros and cons of a menopause clinic

Age at interview: 53
Sex: Female
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I suppose well, it’s a bit unfair because probably if there was a menopause clinic, that sounds terrible, and probably there is because if I went in and asked the practice nurse in one of these the information is probably there. But you tend not to until you’re called because it’s your smear test is due or you’re due an MOT if you like. I’m not sure if it would be worthwhile having one that’s actually entitled that, I mean it might put people off I’m not entirely sure. It’s like all these things I think if you want to ask or you’re desperate to know something and you ask the information will be there. It’s just for those who perhaps don’t want to put themselves out or feel awkward in asking that it’s not flagged specifically. It’s, and again a two edged sword, whether it’s entitled a menopause clinic or something would, “Oh, I’m not going in that door.” So there’s pros and cons for having it sort of specially.

Why do you think women wouldn’t go if you had a menopause clinic?

Well, some people wouldn’t. It wouldn’t worry me but some I would imagine wouldn’t like to sort of flout that they’re of that age. I mean I don’t know as I say it wouldn’t worry me in the least but that depends what door you’re going through I suppose from the big central area where everybody waits. I’m not sure what else you could call it though.

Why do you think they have that attitude towards it?

Well, I suppose some people don’t want to twig or to let on they’re of that age perhaps. I mean I’ve no idea. As I say, it wouldn’t fuss me in the slightest but I mean I presume some people also feel it’s the end of an era if you like, biologically. That’s it and maybe they don’t want to give off that signal. I don’t know.

Although some people would benefit from these clinics, others would not want to ‘listen to everybody being wretched’. Indeed, many women have few if any problems going through the menopause and little reason to consult their GP let alone attend support groups. For them, the menopause is not a big deal but simply a fact of life.
 

Carolyn had no adverse effects at all during the menopause. She thinks it’s important to remember...

Carolyn had no adverse effects at all during the menopause. She thinks it’s important to remember...

Age at interview: 60
Sex: Female
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I know I feel a bit of a fraud but I sailed through it really fortunately without the need for HRT or anything else.

I have said this to other people that sometimes I think doctors even forget that not everybody’s ill and that actually I’m sure I’m not alone in actually having had a good experience if you want to put it that way. And so sometimes I think you do need to put the good side as well and that you don’t necessarily all go into a decline and have a lot of problems. But I mean there was nothing I could do about it, it’s just that I’ve been fortunate, that’s the way it’s been for me but I say I’m sure I’m not the only one. It’s like doctors I’m sure sometimes think everybody’s ill because they only ever see people who are ill. So just bringing a bit of good news if you like.

Not all women seek help from their GP or practice nurse during the menopause. Those who do; want reassurance, advice, guidance, and timely referral to consultants if necessary. Providing a more comprehensive service which recognises the specific needs of women at midlife is essential if they are to feel well-informed, valued and supported during the menopause.

 


 

 

Last reviewed July 2018.

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