Eddie Morris
Welcome to the Transforming Primary Care podcast. My name’s Eddie Morris. I’m a consultant obstetrician and gynaecologist by training. I’m the regional medical director in the East of England and have been chairman of the British Menopause Society (BMS). So in this episode that marks October’s World Menopause Day, we discuss how primary care colleagues are working together to meet the needs of patients experiencing perimenopausal and menopausal symptoms and we’re going to cover areas such as championing this area of Women’s Health and how it fits into the 10 year health plan and the three big shifts that I know are going to come up through our conversation today.
But joining me today to discuss this subject are a group of GPs who are all working incredibly hard to improve women’s health, in particular the care of women going through the menopause. We’ve got with me today Sangeetha Bommisetty. She’s a GP Partner at Beacon View Medical Centre and clinical lead for Women’s Health in Newcastle Gateshead within the North East and North Cumbria Integrated Care Board.
We’ve got Rabia Aftab, again a GP – Women’s Health Hub lead at Riverside Surgery and East PCN in North Lincolnshire.
Lauren Riley is an advanced clinical practitioner at the Beech Tree Surgery within Humber and North Yorkshire.
Dr Clare Spencer, who’s a GP at Meanwood Health Centre in Leeds, West Yorkshire.
And last but not least, Lindsey Thomas, who’s lead GP at the Menopause and Heavy Menstrual Bleeding Community Clinic in Sheffield in South Yorkshire.
So it’s great to have you all here today. So let’s start with a question at the very beginning. What do we mean by menopause and perimenopause and what symptoms can patients experience? Claire, I think you’re going to take this one first.
Clare Spencer
Yeah. Thank you, Eddie. It’s great to be talking this afternoon. So the menopause is best thought of as a transition. It’s where our ovaries gradually stop reliably making oestrogen. And what that means is periods change and then eventually stop as our oestrogen fluctuates significantly and then eventually diminishes, so it’s not measurable.
So the perimenopause is the start of that menopause transition. The menopause itself is confusingly a single point in time when you can look back and say you’ve had no bleed or no period for 12 months, not taking hormones. And then the post-menopause is the rest of your life, which if you look at women’s lifespan is around 40% of the entire lifespan.
And the result of that fluctuating and loss of oestrogen are a myriad of symptoms and they basically fall under 4 main headings or five main headings. Vasomotor – so hot flushes, night sweats, physical symptoms for which there are so many because that really reflects how important oestrogen is around the body.
Psychological symptoms as the change and drop in oestrogen affects neurochemicals in our brain. So there can be anxiety and lower mood all the way to depression. Cognitive symptoms as our brain changes structure and function during that menopause transition and then genitourinary symptoms. So vaginal dryness, soreness, irritation and bladder symptoms.
And so the average age of the menopause in the UK is 51. The normal age range is 45 to 55, but about 1% of women will go through the menopause, maybe even higher than that before the age of 40. That’s premature ovarian insufficiency either naturally or due to treatment such as chemotherapy, radiotherapy or if ovaries are removed then that can occur at any age. And then an early menopause is a menopause between the age of 40 and 45. So huge range of symptoms, huge range of severity of symptoms and a big age range also in which women can go through this transition.
Edward Morris
Thank you very much, Clare. I mean, that really gives a very thorough overview of menopausal transition. And you touched on the point about the fact that women are menopausal for the rest of their life. And quite often we have patients who are somewhat confused by the fact they thought they will have gone through the menopause and it’s all done and that in itself is an education piece. Does anyone else want to add anything to Claire’s really extensive answer there?
Well, if not, we can move on to how we can work out with our patients which symptoms are hormonal and which ones are not hormonal and how we can have other ways in which we can manage symptoms, maybe through a combination of hormonal and non-hormonal. Lindsey:
Lindsey Thomas
So I think that’s often a cause of sort of apprehension and a bit of confusion amongst patients themselves and clinicians as to how to absolutely, definitely know that that’s what’s causing those symptoms.
And I think what can be really helpful is encouraging women to keep symptom diaries so that they can be aware of what is happening with their symptoms, what breadth of symptoms they’re experiencing, but also for women, particularly in the perimenopause, when it’s most difficult to know because they’re still having periods, is looking for really subtle cycle changes.
We often think of the menopause, or the menopause is often thought of as periods having completely stopped or women starting to miss cycles.
Actually, in early perimenopause, it’s much more subtle than that. And women might say yes, they are still having a regular period, but it might have changed from being every 28, every 30 days to being more sort of every 24/26 days.
And I think that’s often quite helpful to concentrate on those subtle cycle changes alongside symptoms and also appreciating that in the perimenopause, because the ovaries are behaving in a really chaotic way, that symptoms are not linear.
So not dismissing women if they’ll say they have symptoms some of the times and not at others, or they only have symptoms at certain times in their cycles, such as just before a period when their oestrogen levels are naturally at their lowest, so I think monitoring can be helpful, but also really listening to women.
I think over the last number of years I’ve really, you know, I’m really passionate about the fact that women do know their bodies. They have cycled throughout their whole lives and have an appreciation of how they feel.And I think women are really good at pinpointing what feels like it’s hormonal and what feels like it’s something else.
Eddie Morris
That’s a great point to raise. I mean, it’s so often that I see people in clinic who haven’t been listened to and actually giving them the time to listen to the whole story can often sort out context and pretty much point you in the right direction of how to how to manage her best. Sangeetha.
Sangeetha Bommisetty
Thank you very much, Eddie, and thank you, Claire and Lindsey. So another point that I did want to raise is that very much the base of motor symptoms seem to predominate our questioning when it comes to the start of the menopause and as you said, the subtlety of period changes. But another thing that I personally experience certainly is that slight cognitive dissonance or the brain fog that we all kind of that women tend to kind of talk about.
There’s a longitudinal study that’s ongoing isn’t there at this moment in time and do correct me if I’m wrong, but it is a study of women’s health across the nations, which is still ongoing – I understand, has been ongoing for the past 25 years – and they have found that those neuroendocrine changes in many women – that brain fog- can actually kind of precede even the subtle period changes that we appreciate.
And I certainly know from personal experience that I have always taken great pride in my memory and I could not remember a floor-by-floor account of a movie and I was trying to relay it and I thought ‘what is happening to me?’ and that interestingly, is quite a frightening experience till you actually realise that this potentially is one of the symptoms of menopause.
So, I think maybe kind of also understanding that when women present to us with mental health symptoms or for that matter, you know, cognitive dissonance, for want of a better word, that that’s something we do need to appreciate and potentially think of – the menopause as a wider contributing factor.
Eddie Morris
Very, very well said. And certainly one of my mantras in life with my patients is that no one woman’s menopause is the same as the other. And that’s why you really got to understand that a lot of these things are temporally related to the changes in her life. What do people think about blood tests? Provocative question there, Rabia.
Rabia Aftab
Thank you, Eddie. I, as Clare said, the symptoms of menopause are so varied and so widespread, it is often very difficult to diagnose it and unfortunately the expectation from patients still – despite all the advice on media and plenty of patient information leaflets and resources- is that somehow a blood test will diagnose perimenopause and menopause.
We know the importance of other blood tests, for example checking anaemia levels, for example thyroid function when they have different symptoms but checking hormonal levels is often unnecessary and not productive. And this I see within, you know, my colleagues’ practice and my own practice certainly, is a big frustration – that lack of certainty and that lack of diagnostics.
And therefore, unfortunately, many women are misdiagnosed with having anxiety, depression, fibromyalgia, chronic fatigue syndrome, chronic pains and given the wrong treatment.
Eddie Morris
Absolutely right. Clare, you want to come in here as well?
Clare Spencer
So absolutely. In the specialist clinic, I’m seeing more and more women have had estradiol levels checked when they’re taking HRT and there are huge limitations to this. If you’re measuring an estradiol on HRT when somebody’s in the perimenopause, there is no way of differentiating between what the proportion of the estradiol is the woman’s own endogenous oestrogen and how much is from the HRT.
And when we look at the evidence around estradiol and clinical symptoms, again that is very poor correlation. So I’m seeing women who’ve been told that they’ve been needing to be aiming for a certain estradiol of a.certain number and often their HRT doses increase to try and get to that number and then they experience side effects.
And so it’s understanding that even a serum oestrogen or serum estradiol, there are many, many limitations to measuring it and it is virtually pointless measuring it in the perimenopause.
Eddie Morris
Thank you for that clarification. Yes, it’s extremely unhelpful. In fact, NICE has guidance about not to do it and it’s sometimes useful in women on treatment who are menopausal, just if they’re not having the response you would expect or you’re waiting to see if there’s been a change in in dose. Sometimes, but not always. And so the BMS has some helpful tips there on their website as well. Lindsey –
Lindsey Thomas
Just coming back to using blood tests for diagnosis, I think it’s still something that clinicians fall back to because there has been, you know, there’s been such a lot of misinformation about HRT over the last sort of 10/15 years that I think people have felt that they really need something robust to be able to make a diagnosis, particularly if they’re thinking about prescribing HRT.
So I think moving away from using blood tests for diagnosis also means making people feel more confident with HRT prescribing and the myths around that. Because actually if you think that this is perimenopause or menopause and you’ve ruled out other things if you felt you’ve needed to, you’re actually not going to go far wrong for most women if they’re wanting help by giving them a trial of HRT and seeing if that helps.
And I think that, you know, that caution and that worry around that is probably what leads to people doing blood tests and then saying to women, no, no, no, it’s not that because your blood tests aren’t suggesting.
Eddie Morris
You’re right there. Common things are common, aren’t they? And I think if it looks like menopause and smells like menopause, it is most likely to be menopause. OK, fantastic. Well, I think we’ve got off to a fantastic start here. Thank you very much everyone. So shall we move on a little bit and see what you’re doing in the North East and Yorkshire region, I’ve got a list of the things that you that you’re doing. So Lauren, do you want to start with an outline of what you’re up to, the initiatives you’re working on?
Lauren Riley
Yeah, so as part of my role as Women’s Health Champion for the PCN in our area, we have used some funding to upskill people in different surgeries, so particularly on LARC training because a lot of the surgeries in the area weren’t.LARC fitters and to offer the BMS menopause course to the clinicians as well, which has been really successful and we’ve got more and more people feeling more confident in those areas now.
So that’s been good in particular in the surgery that I work at, I developed a menopause group consultation. So I found that most days I was seeing 4/5/6 ladies come in with very, very similar complaints, if you like, and they all were asking very similar questions and I was saying the same thing over and over. And I wanted to try and give these women more time because 15 minutes is impossible to do a really good menopause consultation. I’ve barely got to know the name and how they’re feeling in 15 minutes, never mind try and speak about HRT.
So I designed a menopause group consultation where I have around eight women. They get an hour to an hour and a half with myself and the PCN dietitian was on board initially as well. And we go through what is perimenopause, what is menopause, talk about diet and lifestyle and treatments for perimenopause and menopause. And it’s an open forum where they can ask lots of questions, learn from each other in particular.
So a lot of women will say after the group that oh, I thought it was just me that felt like that. I live in a house with teenage boys and men and I’ felt like I was alone and none of my friends are talking about this because I’m a little bit older or a little bit younger or’ and so they’re learning from each other and they feel less alone. And actually it’s been a really, really good response. And I’ve had a lot of women from the group that have stayed in touch afterwards and like almost built a little support network. So I think the menopause group has been really, really successful in in that sense.
Eddie Morris
Wonderful. Now you’re absolutely right there. I think those group sessions can be really helpful for the shared experience elements. As I’m sure you found some women need individual discussions at some points, but actually that those group things help – the group consultations, but the group discussions as well help people feel less sort of alone with their symptoms and it helps some of the sensations of isolation that can happen during the transition.
Lauren Riley
Yeah, and it’s a really good opportunity for future health prevention as well. You know, to talk about bone health, like blood pressure. You know, some women don’t come to the GP surgery and haven’t had a blood pressure check for goodness knows how long. So they all get a blood pressure reading done when they come in and we talk about cardiovascular health and things like that, though it’s a good opportunity for disease prevention as well.
Eddie Morris
Rabia, how about you? Thank you.
Rabia Aftab
Thank you. So inspired by Lauren’s work, we are aiming to set up group consultations in our practice for the PCN. So we have 4 practices in our PCN or large practices. For the time being, what we’ve been doing since April this year is a bespoke menopause clinic using the latter half of an extended access clinic. So as you know, all GP practices offer extended access on Saturday from 9am to 5am.
We have broken that down and from 1:00 PM to 5:00 pm we have said that this will be a specific menopause clinic for patients who have perimenopausal or menopausal symptoms. We offer 30 minute appointments, so obviously longer than the 15 minutes, and we try to listen and get to the core of the problem and give them the right treatment at the right time. If I may use this opportunity to quote a patient, I’ve taken consent from them, which pretty much sums up what we are doing.
So this patient says:
“that after a couple of years of experiencing a range of symptoms that affected my life hugely, I began my research and came to the conclusion that I was potentially perimenopausal. However, this possibility was previously dismissed many times by doctors, mainly due to my age and my blood tests appearing normal.
“Fortunately, I was able come to this particular clinic, which is the menopause clinic. The doctors took the time to really listen to and was incredibly therapeutic in itself. I felt truly heard and understood. They looked at my symptoms holistically rather than in isolation and helped me gain a closer understanding of peri menopause. I was given lots of detail and it empowered me to make a decision. I was given HRT promptly.
“I cannot put in words the difference it has made in a couple of months. I have stopped crying. My anxiety has significantly reduced, my tempers under control and my aches and pains and brain fog have started disappear. I just feel incredibly fortunate to have received the support, especially knowing that many of my peers are still struggling to access any help at all. More women deserve the opportunity to redeem their lives rather than have hormonal changes continue to impact their ability to function day-to-day.”
So this just summarises the experience of one patient and we have offered over 180 appointments so far, like I said, in this bespoke menopause clinic and we aim to now offer a group consultation model as well going forward.
Eddie Morris
Fabulous. What great feedback. Nothing better than that sort of feedback. OK, Sangeetha, how about the work you’ve been doing?
Sangeetha Bommisetty
Thank you, Eddie. I would really like to showcase some of the amazing work that’s been happening across the Northeast and North Cumbria footprint.
Across NENC, we are really proud to host three women’s health hubs, and all three of them have been testing a unique model. In Sunderland, the hub is predominantly a single-site centre that truly functions as a one-stop shop. It offers a whole range of women’s health services, but uniquely pelvic ultrasound on-site, and that gives women certainly a streamlined pathway to diagnosis and treatment under one roof.
In North Cumbria, there’s a huge rural footprint, and the model has evolved through sexual health services into a hub and satellite system, trying to take care closer to women wherever they live. And in Gateshead, the focus has been on bridging that interface between primary and secondary care.
The Acute Trust has been acting as the hub of expertise, where our primary care networks have been serving as spokes, and they’ve been delivering local education sessions about menstrual health, the menopause, cervical screening, and delivering LARC -long acting reversible contraceptives – for non-contraceptive indications such as HRT.
But across all three hubs, we have been building strong links with our mental health leads to ensure that there is visible signposting to mental health resources.
And – I need to mention our VCS partners because they’ve been running menopause cafes and actually taking these conversations right into communities where they’ve been creating safe spaces where women can learn, share, and feel heard.
I’m going to talk about gynaecology waiting lists, which we know is a huge problem right across the country. So in Gateshead, we’ve developed the Women’s Health Gateway, where we’re hoping to address this by using capacity across the system way more intelligently.
And alongside this, we’ve developed the Chronic Pelvic Pain Service, which integrates gynae, anaesthetics, psychology, and primary care to help women not just manage their pain, but to regain their well-being and return to work.
So together, I’m going to say these hubs are reshaping the landscape of women’s health. It’s bringing care closer, it’s reconnecting services, and its truly centre-ing women and I feel so proud to be part of this work.
Eddie Morris
Yeah. Well, thank you. I mean, that’s the sounds of a Women’s Health hub working at its best. So well done. Well done, you and the team. OK, well, let’s move on to Lindsey. I think you’re the final one to chip in here. Over to you.
Lindsey Thomas
One, thank you, Eddie. So it’s really interesting to hear what everyone else is doing. So in Sheffield at the moment, I am leading on a pilot clinic for menstrual and menopause issues. In South Yorkshire all of the women’s health strategy money that was given to each ICB was divided it between the four areas that there are in South Yorkshire.
So Sheffield ended up with 1/4 of that and by looking at what obviously in the women’s health strategy, there were core specific areas that were being focused on to try and make sure that these were being covered and Sheffield already has really good provision for contraception for long acting reversible contraception (LARC) and also for some community gynae procedures like polyp removal, propel, those sorts of things. So we looked at where were the areas that we weren’t covering and really that was to do with rather than sort of treatment or procedures looking at assessment.
And also looking at where was the most need in secondary care because obviously we’ve been working collaboratively with our gynaecology colleagues and the menopause clinic had up to nearly a year’s wait to be seen and also women with sort of non-urgent menstrual problems obviously falling to the bottom of the list to be seen as well. So the pilot started in March of this year and so far, we’ve just had a six-month interim review and it’s had a huge impact.
So I’m really pleased with how it’s going. We’ve hugely impacted on gynaecology waiting lists, particularly for menopause and the queue that they have got, which was huge previously. So we’re really pleased with the impact that’s making. We’re quite lucky that in Sheffield there is also a layer of triage before we get to the hub. So there is a system called CASES which runs there for all sorts of different specialties, so gynaecology, gastroenterology, there is specialist GPs triage those referrals to already try and give advice and guidance back to primary care or filter out what really needs to go into secondary care.
So that process is happening even before it gets to the women’s health hub. So that’s worked really well. It’s not mandated that GPs have to use the CASES triage, but what has been happening is that since there has been the availability of an alternative service to refer into that actually the triage service has been being used much more because that is the gateway into the women’s health hub, which obviously has had its benefits because not all of that needs to be seen.
Some of that is going back as advice and guidance, whereas it would have gone directly onto a gynaecology waiting list. So, so far it seems to be working really well. I think across the country we’ve got these amazing services, they’re showing real impact -what is really difficult is that the funding from the women’s health strategy is non-recurrent. So it’s very difficult to make plans for a service or really, you know, hone and improve where a service can go, start doing training of ACPs etc without knowing is this service going to continue?
Edward Morris
Yes. Well, I think that that’s an interesting direction that I think has to be thought very clearly because we look at the three big shifts, you know, we’ve got to shift some of the funding that’s going into secondary care at the moment closer to home.
And that’s all about from the hospital into community shift, isn’t it? And I completely agree, Lindsey, I mean.the primary women’s health hubs from what we’ve heard today, the great examples that you have is really it has really got some great services up and running. That’s that Sangeetha’s outlined, that you’ve outlined, that Lauren’s outlined.
But I think it’s keeping them going is going to be very much part of the challenge that ICB commissioners are going to have in the coming months and years. OK, let’s move on a little bit. I’ve got, I’ve got people very keen to come in, but I think what I’d like to talk about is now what your advice would be for colleagues who are considering maybe moving into this area of menopause care or optimising the care that they give. So let’s kick off with Rabia. Have you got any suggestions here?
Rabia Aftab
Thank you, Eddie. I think my suggestion would be what I’m actually trialling and erroring at the moment and it’s going so well – is bespoke menopause clinics. I do agree with Lauren in terms of 10/15 minutes is not sufficient for a patient to open up the variety of symptoms menopause can cause and then really explaining what they’ve been going through, you know how they’ve been not listened to, and how is it that their expectation is, you know, XYZ.
So I do think we need to start with listening skills, giving them the time and also someone who is specialised enough to understand, you know what menopause does to the body, understand the symptoms and what treatment options are there and not be apprehensive about prescribing HRT.
Like Lindsey said, you know, HRT is the gold standard and something as simple, as inexpensive and as magical as HRT shouldn’t be denied to patients. So I would certainly say consider running bespoke specialised menopause clinics at primary care level, which then goes in line with the 10 year NHS plan bringing care from the hospital into the community.
Eddie Morris
Fabulous and Clare.
Clare Spencer
Thank you. I completely agree with you. I think so some practices, for example my practice, we still have 10 minutes appointments and we’re working under enormous pressure to try and see volumes of patients and menopause patients need time and they need listening to, to validate symptoms, to take away some of the anxiety about what’s going on and have a strategy to go forward.
But I think that we have to also be realistic in what we can offer. And so I think it’s so important to have loads of accessible information for your community because every practice’s needs – every practice’s population will vary in ethnicity, for example, accessible information on the websites and in the practice. And I think having one person in the practice, it might be a practice nurse, it might be a pharmacist, it might be a GP with the additional knowledge.
So when questions do come up, you know who to ask within the practice. But then also in Leeds, I’m really proud of the advice and guidance service that I can offer -that we can offer from our specialist menopause service that does sit actually in primary care again and having- being able to upskill GPs and give confidence to GPs to diagnose and manage the menopause for their patients. And then obviously it’s so important to have a referral -into service when GPs are struggling or patients are more complex.
Eddie Morris
I completely agree. Sangeetha, you want to come in there.
Sangeetha Bommisetty
I think it’s about starting small but being visible, isn’t it? And we’ve been talking about also enlisting the help of the wider community and our VCS colleagues, VCSE colleagues. We’ve had menopause cafes running and active running in communities.
For example, just recently Sam Allen, our CEO, kind of went out, a chief exec went to a menopause cafe on Stockton High Street and she was talking about how a lady came up to her and was talking about how the BCFE colleagues had gone into the Sikh temple and had a session and how welcomed it was in that in a safe atmosphere, they felt comfortable to talk about the menopause.
And it is something kind of when we were talking about the fact that culturally sometimes some of our communities, our minoritised communities do not really kind of talk about the menopause. There’s something that just kind of disappears in the annals of time. And I think this is once again about trying to address that by taking care out there, by improving knowledge.
Another thing that we have certainly done is, as Clare mentioned, is menopause champions and that’s something that certainly is work that we have pushed out there into the community where there is a recognised menopause champion within each practice. So hopefully that will actually be a source of where women can actually or even practice staff can go in to have a discussion.
Eddie Morris
Excellent. Thank you. Lindsey, how do you feel about this?
Lindsey Thomas
In terms of learnings that we can take forward, Eddie? So I think I totally agree with Clare and obviously I’ve been lucky to work alongside Clare and I’ve seen how well her service is working. But I think we really do need to be reaching out into communities because one thing that I feel quite strongly about ,is that it’s brilliant that there has been this explosion of menopause awareness.
It’s, you know, all over the media, but that is potentially still a very empowered, well-motivated group of women who are able to come to the doctors and access the help that they need. And I think it’s really important that we are accessing all groups of women. And some people feel much more comfortable doing that within their communities, with support from within their community who can explain things in a way that they find much easier to understand, find it much more approachable.
So I think that that’s really important that we are, you know, reaching into those communities and we can do that much better from smaller hubs which sit within areas with experts within practices and then perhaps feeding into more specialist services. So yeah, I think, I think that’s a bit which we’re going to need to work a little bit more towards.
Eddie Morris
Yep, I completely agree. So if we think about the way that things are being directed nationally with the reorganisation of the NHS, the abolition of NHS England, and this is all being driven by the 3 big shifts and the 10 year plan, I firmly believe as you have all said very clearly, that this area should be an area of healthcare that’s delivered as close to home as possible with secondary care reserved for the very most complex of cases only and I know I have with me today five incredibly effective people when it comes to the treatment of menopause in the community.
How can we use those 3 shifts to make sure that we really do get the focus on menopause care as strong as it can be? And I’ll take any of you to kick off the answer to this question. Clare:
Clare Spencer
I think if you look at disease prevention and the menopause, I mean, it’s such a great argument to put forward for needing effective menopause care and for raising awareness of menopause through all communities.
And just reiterating to all healthcare professionals that the menopause is an opportunity where you have women at a time where their bone loss is accelerating as they lose oestrogen and their risk of heart disease is overtaking that of men.
And if we think about the stark figures, you know, one in two women will suffer a fragility fracture over the age of 50. And we know that worldwide cardiovascular disease is a leading cause of death for women. And so it really has to be starting, you know, so the menopause is an ideal place to manage the menopause effectively, to talk about HRT and whether it’s going to be appropriate or not.
But also, as we’ve mentioned already, it’s a time where you can talk about risk factors for osteoporosis, taking vitamin D, looking at lifestyle, checking lipids, checking blood pressure and really starting from the beginning, but educating women, education, education, education and really highlighting this is a time where you can make a difference that will help in the rest of your life.
Eddie Morris
Fabulous. I mean, I’ve always sold the message that it is a great preventative medicine opportunity and not just HRT. So many other things that you covered beautifully there, Clare. Sangeetha:
Sangeetha Bommisetty
Thanks Eddie and thank you, Claire, because that’s a great example of kind of moving very much from reactive to that proactive care that we talk about is one of the main shifts, don’t we?
And I’m going to talk about silo to this whole multidisciplinary collaboration, which is very much kind of the whole focus of this women’s health gateway we have going in Gateshead because it’s about moving away from hospital gynaecology, community gynaecology and general practice with special interests and actually bringing it all into one neighbourhood where you can collaborate, you can educate, you can improve, you can upskill and you can get the right care the very first time, first place.
So yes, so this is kind of true partnership that we’re talking about – so very much that one shift to multidisciplinary working that I absolutely endorse.
Eddie Morris
Thank you. Well, next we have Lindsey.
Lindsey Thomas
I think menopause completely agree with everything Clare and Sangeetha have said, but I think the menopause is almost the perfect illustration of, you know, the idea of those 3 shifts. It fits perfectly into how that could work, bringing it into community you know there’s such a breadth of experience there.
Eddie Morris
Thank you very much Clare. Ok, next is Lauren.
Lauren Riley
Yeah, I just wanted to mention about – obviously looking at it from a prevention point of view – upskilling more clinicians. So it doesn’t have to be a GP for everything. So I’m an advanced clinical practitioner and there are lots and lots of wonderful nurses and advanced clinical practitioners out there that that do some fantastic work and I think we need to push that more and educate and upskill more clinicians.
So I do a lot of work with women with learning disabilities. So we know that women with Down Syndrome in particular can experience menopause symptoms earlier and often get misdiagnosed with dementia – so a step that we’ve put in place there from a preventive point of view is sending out a pack, an easy read pack with a symptom profile on there and they all get sent that at the age of 30.
So it’s already in the mind and it’s already been spoken about with pictures and an easy read. It’s there ready for prevention so that we don’t get to the point of them coming in really, really struggling because we’ve got there quite early with it.
Eddie Morris
And Clare?
Clare Spencer
Yes. And just to add on to what Lauren’s just been saying, I completely agree about upskilling other healthcare professionals. So within Leeds, we’ve taken additional roles reimbursement scheme money and used that to train a cohort of pharmacists who’ve been seeing patients. So the receptionists have been signposting to a pharmacy appointment, which is a lovely 30 minute appointment with a pharmacist who I’ve trained and I debrief them every two weeks.
They can contact me for advice and guidance and actually that’s worked really well since that scheme started last year. They’ve taken 507 appointments just over two pharmacists from the GP load. So I completely agree it has to be a wider discussion, not just GPs
Eddie Morris
Thank you very much, Clare. Lindsey.
Lindsey Thomas
And I agree, Clare, with this being 51% of the population, we need to be upskilling. This needs to be standard, doesn’t it? In general practice, most women are quite straightforward and we need to make sure that we are providing that education so it filters down.
In Sheffield, we’ve tried to focus on what are the key themes which are coming through as referrals to clinic and then we took the opportunity of one of our citywide learning afternoons to focus on those key areas so that hopefully we’ve already been able to feedback what we’ve seen coming through clinic over the next six months and hopefully reduce that coming through because we’ve been able to filter that education through.
But I think it is really important that there is this sort of ladder system, isn’t there, of, you know, most of this care taking place just in in routine general practice surgeries.
Eddie Morris
Must never forget to recognise that there’s so much going on in the routine work in general practice. Sangeetha?
Sangeetha Bommisetty
One thing I wanted to talk about was about menopause in the workplace, and it’s about kind of looking at your own, isn’t it? It’s about the fact that you need to look within your organisations to realise that and to understand as to what impact the menopause is having on your workforce and what can you do to improve the conditions within your working life to understand and to drive things forward.
So the fact that the ICB now has a menopause in the workplace policy that is being actively promoted I think is a really good piece of work and I feel that needs to kind of be replicated. As a small GP practice, I know that potentially we don’t have that, but it’s very much a case of adopting that policy within our practices and our PCNs and making sure that once again there’s recognition as it’s great to drive it forward for our patients, but this is about care being at home in a manner of speaking.
Eddie Morris
Thank you. I think to wrap it up, Rabia.
Rabia Aftab
Thank you. Just very quickly on top of that, of course also educating and upskilling clinicians in terms of being comfortable with prescribing the gold standard treatment, which is HRT. I’ve got some statistics from the menopause charity.
I’ll very quickly share them because they really do make the case compelling. If HRT is started within the 10 years of menopause. It reduces the risk of diabetes by 30%. It reduces cardiovascular disease by 50% and mortality by a staggering 30%. So we know how it can really improve a woman’s health and longevity. Sadly, despite favourable benefit risk profile, the prescribing rates of HRT remain low. So I think that’s something we really need to work on. Thank you.
Eddie Morris
Thank you, Rabia. Yeah, thank you, Rabia. I think it’s always important to know that with those great statistics about the preventative potential of HRT, the license at the moment in for prevention is that for osteoporosis and not for cardiovascular disease at the moment. It’s certainly something that we talk about with patients to help make sure they get a complete picture of the benefits of HRT.
Well, I’d just like to say thank you. Thank you to Claire, Sangeetha, Rabia, Lauren and Lindsey. It’s been a great conversation. I’ve really enjoyed it. It’s great hearing to begin with the projects that you are doing in the region, very effective women’s health hubs, education and including more professionals working in this area in your region, and I hope for people who’ve been listening to this podcast that you’ve heard some things that you could do to take away to include into your practice.
I hope you, I hope you’ve enjoyed listening and thank you very much.
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