Doctor’s appointments can be stressful experiences and even more so during the menopause when you may find yourself feeling anxious, depressed, forgetful and generally overwhelmed by your symptoms.
Often, by the time women bring up the subject of the menopause with their doctors, they’re at their wits end. Many avoid it because it can feel embarrassing discussing sexual problems with a doctor, particularly if it’s a male doctor.
What do Women Need from their Doctors during Menopause?
What we need from our GPs is reassurance that we’re not going mad and that our symptoms are normal for a woman going through menopause. We also want up to date information on treatment options for the menopause and to feel listened to by someone who is approachable, sympathetic and supportive.
Unfortunately, this is often not the case and many women end up feeling angry, helpless and fobbed off when they try to discuss their menopausal symptoms with their GP. Or you may find yourself dealing with a GP who knows less about the menopause than you do.
In my own case, I suspected I was perimenopausal but when I discussed the possibility of HRT with my GP (who is a lovely man and usually excellent at diagnosis) he said that HRT was only prescribed for women who had already gone through the menopause (i.e. had not had a period for at least one year).
You have only to take a look at recent statements issued by the British Menopause Society (or scan the health pages of The Daily Mail) to realise that this is an outdated and incorrect approach.
Is Your Doctor Informed about the Menopause?
The fact is that many GPs do not feel confident prescribing HRT. The reasons for this may be two-fold.
- Lack of education and training and
- The American Women’s Health Initiative (WHI) study (published in 2002), part of which was stopped early because women using HRT were seen to be at higher risk of breast cancer. As a result, an entire generation of GPs were too afraid to prescribe HRT. There has since been much criticism of this study and the subsequent health scare because the average age of the women in the study was 63 years which completely skewed the results. It is now accepted safe to take HRT up to the age of 60.
UK Doctors need better Education about the Menopause
In defence of GPs, it must be said that they can’t be expected to know everything. They are General Practitioners so they know a little about a lot. Their job is stressful. They have a limited amount of time to spend with patients and a very heavy workload.
However, there is no doubt in the minds of menopause specialists that GPs in the UK need more training and information about the menopause.
In a debate on the advantages and disadvantages of HRT at The Guild of Health Writers in December 2013, Consultant Obstetrician and Gynaecologist Mr Tim Hillard said that there is a whole generation of doctors and gynaecologists ‘who know nothing about the menopause’ because they’ve had no education.
This means that many GPs are not in a position to educate their menopausal patients.
The British Menopause Society runs training courses for GPs but these are optional and doctors are under no obligation to attend them. Unfortunately, this means that the few who are interested are up to date, but those GPs who are uninformed about the menopause remain in the dark.
Writing inPost Reproductive Health: The Journal of The British Menopause Society in September 2011, editors Edward Morris and Heather Currie suggest that:
“… education about menopause, the consequences of estrogen deficiency and treatment options should extend well beyond interested general practitioners, practice nurses and gynaecologists, but should include all general practitioners, practice nurses and gynaecologists, psychiatrists, psychologists, physiotherapists, cardiologists, rheumatologists, surgeons and pharmacists, to name just a few; all may be dealing on a daily basis with patients experiencing consequences of estrogen deficiency.”
NICE Clinical Guideline on the Menopause
Before you give up on your GP and the NHS entirely, let me assure you there are signs of change on the horizon. The Department of Health has asked The National Institute for Health and Care Excellence (NICE) to develop a clinical guideline onthe ‘diagnosis and management of menopause’.
The Guideline Development Group is chaired by Professor of Gynaecology, Mary Ann Lumsden, and includes gynaecologists, specialist GPs, specialist menopause nurses and physicians as well as stakeholders such as the British Menopause Society and Women’s Health Alliance.
The menopause guideline will :
- Offer broad guidance on the management of the menopause
- Be based on the best clinical evidence
- Take account of clinical and cost effectiveness
- Take account of the patient perspective.
It is currently in preparation and due to be published in July 2015. Once available, it will be used throughout the NHS.
A Call for Change
The NICE Menopause Guideline is a step in the right direction. But I think it needs to go further than that. It needs to start with changes in the medical school curriculum and GP education and further training so that all GPs are experienced and knowledgeable about HRT and the menopause.
There is also a need for more menopause specialists and menopause clinics to cope with the growing demand from women for guidance and treatment during menopause.
Given that roughly 50% of the population are women and ALL women are going to experience menopause at some stage of their lives, don’t GPs owe it to their female patients to provide them with the best possible care? Modern medicine is enabling us to live longer than ever before, but there’s little joy in living longer if we’re not healthy in our old age.
The 2013 British Menopause Society & Women’s Health Concern recommendations on hormone replacement therapy: http://min.sagepub.com/content/19/2/59.full.pdf+html
Scope of the NICE Menopause Guideline: http://www.nice.org.uk/nicemedia/live/13891/64883/64883.pdf
The British Menopause Society: http://www.thebms.org.uk/index.php
Photo: Thanks to Mercy Health on Flickr.com (CC).