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Menopause

Consulting the doctor about the menopause

No one has to see their doctor when they go through the menopause - women may see the menopause as a normal phase of life and have few if any problems. Others may use self-help measures such as diet and exercise or complementary therapies to relieve the symptoms. Some may mention the menopause in passing when they see their practice nurse. It is often only when women become concerned about symptoms, cannot cope and are at their ‘wits end’ that they see their doctor. Women talked about going to the doctor during the menopause and described positive and negative experiences.

 

Anne hasn’t been bothered by symptoms. Consulting her GP about the menopause would be ‘wasting...

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Age at interview: 58
Sex: Female
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Have you consulted your GP at all about the menopause?

No, quite a long time ago I was getting palpitations and that was before I was 50 and she said, “Well, 50 is usually the age where you get palpitations or menopausal symptoms.” So no, I haven’t. I haven’t been at all. I mean I did mention the last time I saw my doctor I said, “I’ve stopped my periods. I’m assuming I’m in the menopause now.” And she said, “Yes,” That’s all.

So you didn’t mention about the insomnia or anything like that at all?


No, well I didn’t really want to be prescribed any sleeping tablets if that was the case.

Do you feel you got enough information?

Yes, yes through that book. But I mean I didn’t consider going to my GP to ask about it. I felt I’d probably be wasting his time doing that.

Well, I mean it’s only because I haven’t had problems so I guess if I was having a terrible time then I would have gone to see my GP with a specific symptom I think. Or the sort of group of symptoms that I felt were making my life miserable or unbearable. But just I don’t think I’d go and see my doctor just to find out about the menopause because I don’t feel that’s their job. I feel I have to go with a symptom.


What women say about their doctors
A woman may consult her doctor during the menopause for reassurance, support, information and/or advice about treatment options, HRT prescriptions, and/or for referral to a specialist. Women’s experiences vary greatly. At one end of the spectrum, women had only praise for their doctors. They enthused about GPs who were approachable, well informed, supportive, understanding, sympathetic, open and honest. Good doctors made them feel at ease; they explained the menopause process and could discuss various treatment options and possible risks and benefits. Women felt supported in making well-informed choices.
 
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Joyce had a very positive experience when she saw her GP about HRT

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Age at interview: 48
Sex: Female
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But when I went back to see the GP about getting HRT she was absolutely lovely and I would say very responsive. I mean while we haven’t talked about the different forms of HRT and that’s probably got something to do with the fact that the appointments are only five, ten minutes long and during that time she did a cervical examination, a breast examination, talked through the history, so, I guess we ran out of time maybe to talk about the different forms of HRT. I found her supportive on both occasions I was very happy with the service I got from my GP

And so my experience of doctors and healthcare professionals around the whole issue of menopause, HRT, how that then fits with a future contraceptive need, has been nothing but positive, and on each of those occasions I have had those meetings with female doctors, none of whom I think would be of an age to be going through the menopause themselves. So I’ve been really heartened by that.

What was it that made you satisfied with the service they provided?

Sympathy. I think trying to understand my position and wanting to know about me and my life. What was the impact on my life of this change, huge emotional and physical change. And just a genuine I think understanding of the practical and physical effects that it was having on me.

 

Cheryl’s GP was interested in female health which was a ‘great bonus’

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Age at interview: 54
Sex: Female
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I managed finally to get an appointment with our lady doctor. About my age and she has recently retired but she was always very good, very very supportive in anything. So I went along and she never hurried any of the patients, so there was always a long queue for her. And I remember being with her for about an hour and she had the box of tissues ready and I just wept and sobbed and told her all about it and she was marvellous, she just sat back and listened. And this is when she felt that we needed to consider something like HRT, to see whether that would help.

What did you talk about in the consultation? If you can remember back?

Well I was trying to explain how these moods seemed to be taking over and how I felt that this wasn’t right and I think perhaps by then I might have thought well is this to do with the hormones, or is there something else that’s going on. But she was more or less able to reassure me straight away that “it sounds like hormonal,” she said, then like you she said “tell me about it” and I would tell her that, how I felt about things that were going on and my reaction if somebody said the wrong thing, put something in the wrong place. Very sad really isn’t it but I think having someone to talk to and who gave me all the time that I needed to just to get it off my chest was one of the best things possible. So that really helped. That it was recognised.

Others found consultations with the doctor disappointing. Some GPs had a casual, dismissive attitude about the menopause, offering inappropriate or unhelpful suggestions and advice. Women felt that their concerns weren’t taken seriously.
 

Beverley felt ‘fobbed off’ by her GP when she had symptoms in her late thirties

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Age at interview: 50
Sex: Female
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I was in my late thirties and I had been someone who was always regular when it came to my monthly cycle and all of a sudden I missed a couple of months and I went to my doctor’s because I started panicking thinking I was pregnant. Did a pregnancy test and I wasn’t and then I noticed I was getting the sweats. And then I started going to my doctor’s thinking that I might be going through the menopause and they kept fobbing me off saying, “No, you’re not. You’re too young.” Apparently, the normal age is fifty plus and the fact that I was in my late thirties they didn’t think that I was going through it. And I think it took me about two years off and on of going backwards and forwards to my doctor’s before they were able to do, would agree to do the test. Then they rang me and I thought something was really bad and I went in to see them and it confirmed what I had been saying.

 

Karen is not impressed with the doctors in her practice. They’re uninterested and out of touch...

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Age at interview: 61
Sex: Female
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I just haven’t got a very good impression of the NHS lately. One thing you have got a choice of four doctors but I don’t get on particularly well with all of them. The one I’m seeing at the moment for my hiatus hernia I’ve known him for years, been there for years - pictures on his wall of when he was a rugby player - but you go in and he’s looking at his computer screen and they’re all very much like that. You walk in and they say ,“Good morning, how are you?” without even looking at you. I could be somebody completely different and I swear he wouldn’t know who I am. And he fiddles with his computer, “Ah, yes, is it the osteoporosis?” and you say, “Yes” or “No” or whatever, I said I’ve been seeing him because I have a bad back and leg and he sort of looked at me and said, “How’s your weight” and I said, “I’m a lifelong member of Weight Watchers, I do watch it carefully, I’m slightly overweight but not excessively”. “Do you take enough exercise?” I looked at him and I thought you’re about five stone heavier than you were when you took on this practice and I said, “Well yes” at that point I’d only got the one German Shepherd, I said, “I walk several miles a day with my dog. I did have two, I’ve always walked for thirty odd years, rain or shine my dogs need walking,” so he said, “Oh, right”, and you think he doesn’t know me. I’ve been coming to see you for years but you still really don’t recognise me or know me. And that’s the way I feel about most of them there now. So I’m always reluctant to change to another one who knows even less.

Because to me, a problem shared is a problem halved, particularly with somebody else who’s going through it and I don’t particularly feel that a male doctor has got any idea what a middle-aged lady is feeling like. They treat you almost like you’re neurotic, you’re just a middle-aged neurotic lady who’s got too much on her plate. I can remember at one time my doctor actually said to me, “You’ve got to change something in your life” because I honestly was neurotic at the time and as a throw away remark he said, “Change your job, change your husband, but change something”. And it was a throw away remark but in retrospect it was stupid. He hadn’t got a clue and I don’t think a lot of male doctors have. I’m sure there are some nice ones out there who’ve researched it and know what they’re talking about but I think they’re few and far between in local practices.

 

Annette couldn’t read the leaflet her doctor gave her about HRT as she is dyslexic. He wasn’t...

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Age at interview: 46
Sex: Female
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Alright. As I say the menopause hasn’t been easy. I haven’t had what you call HRT but I know there’s lots of things out there you can take and in your body. I think I’m quite a stubborn person in that way. I’m not, as I say, I don’t drink, I don’t smoke, I don’t take anything into my body unless I really know a lot about it. When I did go to the doctor I didn’t find him very helpful, it was like, “Well there’s HRT or you get on with it more or less.” So I just thought, “At the moment I’ll get on with it.”

See I don’t know much about that because when I went to the doctor it was either, “Take that,” or, that’s how I felt, or “Get on with it,” so I took the option of getting on with it.

When you went to the doctor did he explain about what HRT was?

He gave me a leaflet which they all do, but I’m slightly dyslexic anyway, so of course somebody just shoving a leaflet on me.

It doesn’t work.

It’s not as if I can just read it, I have to have somebody to read it, or I’ll read it and think that didn’t make sense to me. So I’d have to have somebody else.

So do you know what it’s for? Do you know what it does?

Not really no.

Satisfaction with the service provided in primary care can depend not only on the personality and expertise of the doctor, but on the relationship between women and their GPs.

The doctor-patient relationship
Traditionally, doctors in our society have been respected for their expertise and ability to heal. Some women have remained loyal to their GPs, unwilling to question or challenge the advice given. More recently, however, as information has become more freely available, some women prefer a more equal partnership with the doctor so that they can discuss symptoms, share ideas and negotiate possible treatments. Conflicts can arise when doctors appear to lack expertise or don’t listen. However, even a woman who is dissatisfied with her GP may be reluctant to move to another doctor or practice.

 

Rose was brought up to accept her doctor’s advice without question. She is more confident now and...

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Age at interview: 50
Sex: Female
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And I know when I started to have the symptoms of the menopause I went to see my GP, when I could no longer manage it myself, and I took their advice and I think that goes back to my working class background in that I’ve been brought up to accept what other people tell me and to deal with it. But actually in hindsight, I shouldn’t have done that, I should have taken more responsibility for my own wellbeing and done that research earlier and asked for that second opinion earlier, asked for that expert advice earlier. But I think going back to my working class roots GPs were Gods and you didn’t think to ever challenge or question their advice to you. And we need to be doing that more because as I get older and I get more educated and I learn more, I realise they’re not Gods, they’re like everybody else they’re doing the best job that they can with the limited amount of information and limited amount of time that they’ve got.

 

Janice doesn’t feel it’s right for her to challenge her GP or change practices

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Age at interview: 59
Sex: Female
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So I got this book, bought this book and it was very interesting and it said you could have tests, is it FSH tests or something and I thought, “Dare I go down to the GP and ask for that. I think I’ll, you know.” It’s far too overly educated here because you’ve got to adopt a certain role for certain GPs. You don’t want to go and give them the impression that you’re more knowledgeable than them. It’s like women don’t. Often in society you have to play a role that you’re not very clever. So you have to play to type don’t you so no, I didn’t. I thought well, it must be lovely if you’ve got that test. You’d have some confirmation one way or the other so I did read lots of interesting things but I couldn’t relate it to what I could do for myself.

I would say in [city] there’s a culture of you often stay with the same GP unless you move. I would say in [city] not many people do shop around, it’s often, “Oh, better the devil you know”, and then you hear shock, horror stories of other GPs and you think, “I’d better stop with mine.” So that I would say in [city] currently, whether that changes with the new NHS Choices or Choose and Book [a service that allows you to choose your hospital or clinic and book an appointment with a specialist], people don’t often change GPs through wanting a different medication.

Women felt that doctors work within constraints which can affect their relationship.

The NHS, health professionals and the menopause
A major problem was limited consultation time. This made it hard for women to talk through how they felt, describe their symptoms and discuss treatment options. Some women thought that limited budgets, time pressures, targets and guidelines restricted the service, help and support health professionals could give menopausal women (see ‘What is the menopause?’). They also noted problems in making appointments and a lack of continuity with GPs. It seemed that the menopause was considered less important than other reasons for consulting the GP.

 

Donna switched GPs so that she could see a doctor more quickly

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Age at interview: 47
Sex: Female
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What was the trigger that sent you off to the GP?

Desperation. Really, yeah. Yeah. I didn’t, I guess that I found that experience mixed actually going to my GP because the negative side of it was that I never saw the same person, over that entire period of about six months, I never actually saw my own GP, but I saw a different GP every time I went, and I was going about once a fortnight.

And then actually what I did is I switched GPs and that’s been fantastic actually.

What made you do that?

One because I wanted some continuity of seeing the same person, and secondly because oh the other problem with the last GP’s practice was that I couldn’t get an appointment for maybe two weeks, you’d have to book when you went in, you’d have to book for two weeks ahead. If you just rang up you could never get an appointment in the same week.

And you couldn’t ask for a specific doctor?

You could, but then you’d be waiting even longer.

I’ve got no issue with the actual GPs, I think the service they provide is fantastic, and I felt very supported and listened to, and respected, but just the access to the service was difficult and when you are feeling that you’re going mad, and then you’re said, “Oh well, if you want to see your GP you’re going to have to wait three weeks,” it’s like, that could push somebody really over the edge. So, with the clinic round the corner, you can get same day or a couple of days maximum really.

The complexities of the menopause meant that it did not fit easily with the priorities of primary care. While trusting their GP’s ability to treat illnesses, some women felt their doctors lacked the specialist knowledge and training they thought was needed to help women with the menopause. Some women thought that GPs tended to make assumptions and adopt a ‘one size fits all’ approach, rather than listening to the concerns of women as individuals and offering a variety of choices.

With access to the internet and information about the menopause readily available, some women felt they knew at least as much as, if not more than, their GP. Dr Sally Hope agreed, saying she often has ‘women coming in who are actually much better informed than the average GP and that’s nice because you educate us as you come into the surgery’.

 

Jackie’s GP was helpful but in her opinion did not know much about the menopause

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Age at interview: 50
Sex: Female
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I had contact with them from when I was surgically menopausal sort of thing. And I knew that the sorts of symptoms that you can encounter could be a bit like a drug withdrawal because your oestrogen if it goes deficient has that sort of bodily effect sort of thing. And so I was thinking right it’s looking as though maybe I need my oestrogen upped but I had to tell my doctor that’s what I thought it was looking like. But she was helpful. And I also felt as though I really wanted to chat with a gynaecologist again, or like a menopause clinic, something like that where a bit more specialist because GPs are sort of cover all for lots of conditions but aren’t always equipped to go into depth with one in particular. Well certainly the menopause is one of the overlooked ones I would say.

Well, I’d have to be honest and say that you feel pretty much on your own even though you’re going, you’re still just a number and you’re being steered in directions that they’re familiar with and they don’t tend to look round the subject too much or treat you as an individual I would say. Definitely.

Are you talking about GPs?

Both, GPs and the people that you come upon in hospitals. I think essentially that’s something you might have to accept because hospitals see an awful lot of people and they can’t tune in to you personally just like that. I think it would be wrong to expect that but I think there’s a lack of care in the way that they approach how they deal with you. They do tend, you do feel a bit as though it's a cattle market and just you know right, next sort of thing.

 

Denise believes the vague nature of menopause symptoms can often make it difficult for doctors to...

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Age at interview: 53
Sex: Female
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No, he’s not too bad actually. He’s a very approachable person but there are some doctors in the practice that I would not have been so comfortable with. They’re perfectly able doctors, I have no doubt. I suppose you probably think, “Older ones are more sympathetic.” And that doesn’t really follow but it’s just a perception if you like, likewise as I say with a female doctor. As I say my own doctor was fine. But again he would rely on you telling him to a degree. I mean he’s seen it all I’m quite sure and he’s good enough to prompt in some circumstances but again it just depends I suspect on the person who’s trying to explain their symptoms especially when they’re so vague very often. And that’s part of the problem. It’s fine if you have a rash or something specific, “This has happened since last week, why?” But it’s much more difficult when it’s sort of very general you don’t feel right or something very, very vague. Which is part of my problem because to be honest I couldn’t give a specific date, time or indeed really specific symptoms. They were all, fairly general.

How comfortable were you when you went to him about the vaginal dryness?

Oh, okay about it in the end. It was factual, it’s something that happens so no, that was just factual. You just have to bite the bullet. I mean, okay, you don’t really relish it but it has to be done, it was not particularly comfortable so.

Women wondered whether the GP was the best person to help with menopausal symptoms. Some felt that apart from prescribing HRT, GPs could do little to help. Some women came away from consultations feeling that they hadn’t had a chance to open up and fully explain their concerns. Others decided to find their own solutions by consulting a herbalist or a specialist (see ‘Hormone replacement therapy (HRT)’ and ‘Complementary therapies’).
 

Cynthia was disappointed her GP could not offer as much support as her herbalist

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Age at interview: 54
Sex: Female
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I think I’ve harped on more than enough of my disappointment with the GP’s casual attitude. I don’t think there’s much more you can say about that. I think that there’s lots of training that could be done there for things to be, for women to not come out feeling like, “Well, I’m on my own with this then.” The person that you turn to that should help you the most is your GP I think and when they don’t I think that’s quite sad. I still feel a bit choked, when I think about when I very first went there how needy you are. But when you are able to suppress all of that they need to be able to look underneath and see that there is this desperate woman sitting there that might look all composed and everything but actually isn’t and you come out feeling desperate. I don’t feel that I should have, I wish my GP had treated me with the same level of attention and respect and caring that my herbalist did. And I know that you could say, “Yeah, but you were paying him.” I was paying him twenty five pounds. I pay more than that in my national insurance. NHS is not free, you are paying for it and I think it’s a shame that my GP didn’t offer me the same level of support that my herbalist offered me.

Is the GP the right person? Are they equipped to deal with it?

No, I think actually if they can’t deal with you, if they can’t devote the right level of time maybe they should refer you. Maybe there should be more menopause clinics so you go there specifically to have help.

 

Deborah describes her consultation with a specialist

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Age at interview: 48
Sex: Female
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But the specialist was more sympathetic, I felt because I’d gone private I’d got more time, he tried drawing diagrams and explaining hormones, but I still don’t get it. So he said that he kind of allowed me to trust him, and I felt that I trusted him, I trusted his specialist knowledge, and his expertise and he said that if I would go along with some treatment, things might get worse, he explained that he would put me through the medical menopause and so things would get worse for well up to six months I think he was saying at that time. But then after that things would improve, so the way he explained, I think, was that my PMS was linked to ovulation, so if he could suppress ovulation then the PMS would go away.

My GP wasn’t happy, I ended up going back to the same practice, but seeing the older doctor who I’d seen before and just, when I’d seen him originally about PMS his response then was, “Oh my wife suffers a lot, so what I suggest you do is stick a flag on your desk and…”, oh, it was just completely inadequate because I wasn’t coping with daily life really.

Although some women spoke highly of their male GPs, many preferred to see a female doctor if possible. Unsure whether male doctors could empathise with the way they felt, women were more comfortable talking about emotional and sensitive issues with another woman. Some women asked specifically to see a female doctor.
 

Marcia felt more comfortable seeing a female GP

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Age at interview: 46
Sex: Female
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I must be honest, I’m not satisfied with both the consultant that I went to see and also my GP. Even because, one of the reasons why he’s my doctor is because I’m concerned that there’s not enough support for women around gynae issues and so when I joined that surgery it was because he was a gynaecologist so I was thinking “Oh good, I’m in good stead for when I start the menopause etc.” And so I’m disappointed that I haven’t been given any literature, there hasn’t been any, there isn’t any support really for women to go out and find out any information about it.

I’ve changed my GP within the practice. I’ve found out that there’s a woman who specialises in gynae issues. So I’ve just registered well I’ve started to see her now.

And is that different?

Yeah, I think it’s a confidence thing as well. I think it’s a confidence thing in terms it’s another woman that you’re able to talk to and she seems more open and we can have a more detailed conversation.

I just feel more comfortable talking to her than talking to the male. I thought when I chose him as my doctor because he was a gynaecologist I thought I would have the confidence but the conversations that we’ve had have just been so matter of fact that that’s why I decided to move.

Some practice nurses were a further source of information and support, particularly when women came for routine cervical screening or blood pressure and weight checks. Time pressures, lack of specialist knowledge and inability to prescribe, however, meant they couldn’t provide more than a basic service.
 

When Sandra asked her practice nurse about the menopause she suggested she talk to the doctor...

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Age at interview: 47
Sex: Female
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Yeah. The practice nurse says, “Oh well you just have to get on with it, it’s just part of being a woman but if you want to book an appointment to go and see your doctor that’s fine. And then she’ll just go briefly through with what’s available but I haven’t got the time at the moment.”

That’s what she said.

That’s what she said. Because you’ve only come in here for I think I went in for a blood test, you’ve only come in for a blood test, and I’ve got so and so after this.

So you specifically asked her about your symptoms and so on?

Yeah. But she said she couldn’t talk to me about it at the time. So I did turn round and say well if I make another appointment she says, “Well I would suggest you make an appointment with your doctor first”.

How do you feel about that?

I was a bit gobsmacked to be quite honest because I thought well they’re supposed to be there to take the pressure off the doctors to a certain degree and it’s a big practice and there’s probably seven nurses there, perhaps I’d just chosen the wrong one. You don’t know.

Despite general satisfaction with the standard of primary care, many menopausal women feel that their needs are not being sufficiently met. In ‘Advice to health professionals’ women suggest ways in which this could be improved.



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Last updated July 2018.

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