Information and advice (Section 7)

Review question (7.2)

‘What are the information needs for women in menopause?’ ¹ (7.2).

This was divided into two parts, what are the areas of information need and how effective are the different delivery methods?

Introduction

Most women are aware of some of the common symptoms that occur at the time of the menopause, e.g. vasomotor symptoms but many are not aware of other problems which can occur after the menopause such as longer term health issues including genitourinary problems, cardiovascular disease, osteoporotic fractures and sexual problems (7.1).

Accurate information for women is essential so that they can make informed evidence-based choices about management options as there are many different interventions including doing nothing. Any discussion around the menopause and information provided must be documented by the HCP.

This section looks at the common areas of information requirements for women and women’s views on the format of the information (7.2).

The focus population was peri- and post-menopausal women, and information was presented separately for:

‘Women with premature ovarian insufficiency’ ¹ (7.2)

Summary of the evidence

Twenty-eight studies were included with some overlap between the two parts of the question. Randomised controlled trials, comparative cohort studies, systematic reviews of qualitative studies and observational studies were examined (7.3).

The majority of women were in natural menopause with a few undergoing surgical menopause or early menopause due to cancer treatments.

The areas of information need were consistent in 12 qualitative studies, but the evidence was of poor quality. ‘The most widely reported area of information – needs was related to the use of HRT’ ¹ (7.5.1).

Methods of information giving included booklets, enhanced booklets with DVD and interactive links, verbal information from HCPs, educational courses and lectures and peer information and support. Randomised and observational studies were included, and the quality of the evidence is considered to be moderate to very low with risk of bias and lack of data to estimate the efficacy of the interventions (7.7.4).

Information needs of women in the menopause

Areas of information need identified in the studies reviewed were consistent.

Fertility was an important area for younger women, particularly when undergoing treatment for cancer, as HCPs tended to give fertility a low priority (7.5.1).

Women undergoing surgical menopause wanted more information about HRT prior to undergoing surgery (7.5.1).

Information about HRT was the most widely reported area of information need. Women wanted more information about the advantages and disadvantages of HRT from their HCP. Also, more information about non-hormonal and non-pharmaceutical treatment options was identified in some studies (7.5.1).

Contraception was an important issue for younger women undergoing natural menopause (7.7.2).

Women also wanted information on the diagnosis of menopause, symptoms, self management, how family history affects risks, sexuality and support systems (7.7.2).

Women felt that this information should be provided by HCPs. Some felt that menopause experts might give better, more accurate information than primary care providers (7.5.1).

Methods of information provision

Booklets and enhanced booklets with DVDs and interactive programmes showed no difference in decision making compared with those who had not seen the booklets (7.5.2).

One RCT found that women had more knowledge about the menopause with the enhanced booklet, but it did not help with decision making in selecting treatment options (7.5.2).

Low-quality evidence indicated that ‘attending an educational course on menopause had a positive impact on women’s decision-making’ ¹ (7.5.2) and increased knowledge compared with those given a booklet (7.5.2).

Doctors were seen as providing good information, although three studies found that some doctors lacked empathy, had strong personal opinions or the women did not understand the information given due to short consultation time and lack of written support (7.5.2).

Two studies found peer support groups to be an effective method of support and communication (7.5.2).

When considering risks, one study found that women preferred bar chart presentations over other formats. Women identified a need to ‘receive lifetime survival information about HRT risks’ ¹ (7.5.2) and clearer factual information so that they could assess the risks and benefits for themselves.

Key points (7.8)

Women in the menopause and their family or carers need information on:

Stages of the menopause (7.8.7)

Women with iatrogenic menopause due to surgery or cancer treatments should be given information about fertility and menopause prior to treatment and should be referred to a menopause specialist. These areas are covered in other sections of the guideline in more detail (7.8.12).

The Guideline Development Group concluded that the above information needs should be covered in a variety of formats including verbal, booklet, enhanced booklet, peer support, educational meetings, and that HCPs should be flexible in their approach to providing this information tailored to each individual woman’s needs (7.7.2).

Implications of this recommendation

Most women will seek information about the menopause from their primary care provider initially. There is therefore a need to improve knowledge about the long-term benefits and risks of HRT. No other treatment is as effective for managing menopausal symptoms. For many women, the benefits outweigh the risks.

This has implications in terms of education for health professionals around the areas outlined above. Many GPs and practice nurses are well informed and aware of the latest evidence and do provide accurate information for their patients. Others may wish to access the joint FRSH/BMS menopause special skills module which is open to both doctors and nurses. This entails attendance at a theoretical course to update knowledge, and some may choose to proceed to the practical training and gain the certificate of menopause care.

Commissioning groups could develop an HRT formulary for Primary Care, with the help of local staff with an interest in menopause, and use briefings and news letters to disseminate information.

Local menopause leads may wish to set up courses to update staff in their own areas.

The BMS organises a series of women’s health meetings which provide up to date, evidence based and practical information to HCPs in a wide variety of locations all over the UK.

Health professionals can download patient information from a variety of excellent websites including NICE and Women’s Health Concern to use with their patients and can access the BMS website for comments on new evidence as it emerges.