Abstract
4–5 July 2019
Oral presentations
BMS Annual Scientific Conference 2019 Winner, Best Free Communication
Cardiovascular markers with micronised progesterone and medroxyprogesterone acetate in combination with transdermal oestradiol in women with premature ovarian insufficiency: A randomised trial
“Good project design, well presented and outcome relevant to clinical practice”
BMS Annual Scientific Conference 2019 Winner, Best Poster
“It’s like we don’t belong here”: The sexual and reproductive health needs of cis-gendered women living with HIV aged ≥40 years attending a London HIV clinic
“Relevant clinical study, well presented and clear message”
Cardiovascular markers with micronised progesterone and medroxyprogesterone acetate in combination with transdermal oestradiol in women with premature ovarian insufficiency: A randomised trial
1Consultant Obstetrician and Gynaecologist, Subspecialist in Reproductive Medicine and Surgery, St Mary’s Hospital, Imperial College Healthcare NHS Trust, UK
2Senior Research Associate, University of Cambridge, UK
3Subspecialist Trainee in Reproductive Medicine and Surgery, Oxford University Hospitals NHS Foundation Trust, UK
4King’s College Hospital NHS Foundation Trust, UK
5Imperial College Healthcare NHS Trust, UK
Introduction
Women with premature ovarian insufficiency (POI) are at an increased risk of ischaemic heart disease (IHD) and mortality secondary to IHD, irrespective of the cause of POI. Vascular aging can now be predicted through an assessment of carotid-femoral pulse wave velocity (cfPWV), a non-invasive emerging cardiogenic biomarker of arterial stiffness. The European Society for Cardiology guidelines have identified cfPWV as the gold standard methodology for cardiovascular risk stratification.
Methods
Prospective open-label randomised trial in women with POI. Subjects were all prescribed Transdermal oestradiol (Evorel® Patches) 50 mcg/day and randomised to one of two treatment arms for 12 months:
§ Cyclical oral micronised progesterone (MP; Utrogestan®) 200 mg for 12 days every 28 days.
§ Cyclical oral medroxyprogesterone acetate (MPA; Provera®) 10 mg for 11 days every 28 days.
Carotid-femoral PWV was measured using an oscillometric technique to acquire the pulse waveform (Vicorder device, Skidmore Medical). Readings were taken at baseline, 3, 6 and 12 months. Multiple logistic regression was performed to compare continuous variables adjusting for age, BMI, and ethnicity.
Results
Baseline data were available for 57 subjects (29 MP; 28 MPA), at three months for 44 subjects (22 MP; 22 MPA), at six months for 36 subjects (17 MP; 19 MPA) and at 12 months for 33 subjects (18MP; 15 MPA). The baseline characteristics of the two study populations were not statistically different. PWV did not significantly change from baseline for both treatment arms, consistent with no changes seen in the augmentation index or pulse pressure readings over the same period. The MP group demonstrated a significant improvement in cardiac output (0.71 ± 1.01, 95% CI 0.20–1.21, p = 0.01), significant reduction in diastolic blood pressure (−3.43 ± 6.31, 95% CI −6.57 to −0.29, p = 0.03) and significant reduction in total peripheral resistance (−0.15 ± 0.19, 95% CI −0.24 to −0.05, p = 0.01) at 12 months compared to baseline. MPA did not demonstrate significant changes in any of the haemodynamic parameters assessed. Furthermore, MP was noted to result in a significant reduction in total peripheral vascular resistance at 12 months when compared to MPA (−18.39 ± 6.83, 95% CI −32.6 to −4.2, p = 0.01).
Conclusion
MP combined with transdermal oestradiol was noted to have a more favourable effect on surrogate markers of cardiovascular disease including diastolic blood pressure, cardiac output, and peripheral vascular resistance when compared to MPA in the management of women with POI.
Sex life survey: The experiences, opinions and attitudes of UK perimenopausal and menopausal women regarding their sex lives
1GP and Menopause Specialist, Newson Health, Stratford-upon-Avon, UK
2Department of Gynaecology, Queen Charlotte’s & Chelsea Hospital and Chelsea & Westminster Hospital, London, UK; Institute of Reproductive and Development Biology, Imperial College London, UK
3Scientific & Medical Affairs Manager, Kora Healthcare, Ireland
Introduction
Women struggle to maintain a satisfying sex life during the menopause.
Aims
The aim of this work was to achieve a better understanding of the experiences of UK perimenopausal and menopausal women regarding their sex lives.
Methods
An opinion poll was conducted with women across the UK who had experienced perimenopause and/or menopause.
Results
The poll was completed by 2000 women across England (83.8%), Scotland (8.35%), Wales (5.9%) and Northern Ireland (1.95%). 38% of women believed that a reduced level of sexual activity had a negative impact on their relationship with their partner. 27% of women felt that their partner was not supportive and understanding of their experience of the perimenopause or menopause. Women reported that the main hindrances to having sex were stress (35.6%), having children (35.4%), loss of spark in their relationship (31.8%), perimenopause/menopause (25.9%), working long hours (25.5%), illness (24%) and vaginal discomfort or dryness (23.6%). The main internal negative drivers that women experienced were mood changes (26.8%), vaginal dryness (21.2%) and vaginal discomfort (20.5%). Moreover, 37.8% of women felt anxious about having sex due to concerns about discomfort, with 52.8% of the participants experiencing discomfort during sex. As a result, 65% of women avoided having sex after experiencing discomfort previously. Also, 32.7% of women did not feel comfortable talking about sexual discomfort caused by the perimenopause/menopause with their partner or friends; 30% of participants were not confident that they knew why they had experienced sexual discomfort previously; 89.3% of participants did not feel embarrassed or ashamed to know they are perimenopausal or menopausal. However, 36.6% of women agreed that the perimenopause or menopause has made their lives less enjoyable. More specifically, 51.8% of the women surveyed indicated that they ‘haven’t felt sexy during the perimenopause/menopause’. The average age at which women began to feel less sexually desirable was 47.7 years old.
Conclusion
There is a need to increase the support that women in the perimenopause and menopause receive from their partners, their workplace, the healthcare profession and society as a whole.
Randomised trial assessing the effect of micronised progesterone and medroxyprogesterone acetate on thrombin generation in women with premature ovarian insufficiency
1Consultant Obstetrician and Gynaecologist, Subspecialist in Reproductive Medicine & Surgery, St Mary’s Hospital, Imperial College Healthcare NHS Trust, UK
2Pathology Department, King’s College Hospital NHS Foundation Trust, UK
3Subspecialist Trainee in Reproductive Medicine and Surgery, Oxford University Hospitals NHS Foundation Trust, UK
4King’s College Hospital NHS Foundation Trust, UK
5Imperial College Healthcare NHS Trust, UK
This research has been undertaken at King’s College Hospital.
Introduction
Menopause beyond the age of 50 years is associated with a pro-thrombotic state secondary to changes in the coagulation pathway. Limited evidence exists on venous thromboembolic (VTE) disease risk in premature ovarian insufficiency (POI). Hormone replacement therapy (HRT) has been implicated in the development of VTE disease, with the route of oestrogen administration and progestogen preparation being independent causative factors. The thrombin generation curve measures four main parameters (lag time, time to peak, peak height and endogenous thrombin potential), differing from classical clotting assays in its ability to globally reflect all three phases of coagulation in contrast to the initiation phase only, better characterising the underlying prothrombotic states.
Methods
Prospective open-label randomised trial in women with POI. All subjects were prescribed Transdermal oestradiol (Evorel® Patches) 50 mcg/day and randomised to one of two treatment arms for 12 months: Cyclical oral micronised progesterone (MP; Utrogestan®) 200 mg for 12 days every 28 days. Cyclical oral medroxyprogesterone acetate (MPA; Provera®) 10 mg for 11 days every 28 days. Samples for thrombin generation and the coagulation profile were taken at baseline and at three months. ANOVA and MANOVA were performed to determine the impact of dependent and independent variables (age/BMI).
Results
Forty-four subjects (21 MP; 23 MPA) underwent sampling for thrombin generation at baseline and 43 (20 MP; 23 MPA) completed a coagulation profile at three months. The baseline characteristics of the two study populations were not statistically different. Thrombin generation parameters demonstrated no statistically significant changes between the two groups after three months and when compared to baseline. MP significantly reduced Protein S (−9.3 ± 15.5%, 95% CI −17.2 to −1.3, p = 0.03) and Antithrombin III (−8.8 ± 11.3%, 95% CI −14.4 to −3.2, p < 0.01) levels after three months. Changes in Protein C levels, however, were not significant. MPA significantly lowered Protein C levels after three months (−11.6 ± 20.5%, 95% CI −20.7 to −2.6, p = 0.01). No significant changes were noted in the Protein S and Antithrombin III levels.
Conclusion
Fluctuations in traditional haemostatic biomarkers were not reproduced by thrombin generation changes, a marker of global coagulation, thus demonstrating no increased thrombotic risk with either progestogen when combined with transdermal oestrogen in the management of women with POI.
15 years follow-up observational study on the use of levonorgestrel intrauterine system (LNG-IUS) providing progestrogenic component of hormone replacement therapy (HRT) along with transdermal oestrogen in perimenopausal women suffering from menorrhagia
1Obstetrician & Gynaecologist, GP, Medway CCG, Kent, UK
2Advanced Nurse Practitioner, Lordswood Healthy Living Centre, Kent, UK
Aims
To study the effectiveness of LNG-IUS (MIRENA) releasing 20 mcg of Levonorgestrel per 24 h providing progestrogenic component of HRT along with transdermal oestrogen in symptomatic perimenopausal women suffering from menorrhagia with or without non-malignant pathologies.
Methods
A total of 673 women aged 39–56, suffering with clinically confirmed menorrhagia were fitted with Mirena after examination, counselling and consent, after excluding pelvic infections and serious pathologies by endometrial biopsy and pelvic ultrasound scan and blood tests, for example sugar, haemoglobin (Hb), FBC, thyroid function, hormone profile. Pathologies were dysfunctional uterine bleeding 57%, fibroid <5 cm 33%, endometriosis 6%, and endometrial hyperplasia 4%. Oestrogen was given by transdermal route, PATCHES 41%, IMPLANTS 35%, GEL 24%. Yearly Pelvic USS was done on appropriate patients to assess endometrium and fibroid size or in patients with complications. Patients were followed up at 2, 6, 12 months, and then yearly. Data were collected on bleeding patterns, menstrual blood loss (MBL), symptomatic improvement, premenstrual symptoms (PMS), weight changes, side effects, removal, satisfaction and surgical interventions.
Results
MIRENA proved to be highly effective in controlling menorrhagia, improving menopausal symptoms, providing contraception with no reported pregnancy. After 12–24 months of insertion, 61%became amenorrhoic, 18% oligomenorrhoic, with reduction of MBL 85% (75–95%). Ten percent had occ. Spotting for 1–2 days, 4% had light monthly periods with reduction of MBL >95%and >75%, respectively. Ten percent patients with fibroids, 5% with endometriosis continued with irregular light or heavy prolonged bleeding with abdominal or pelvic pains, and of these 5% eventually led to removal after 3–12 months. Nine percent of patients were lost to follow-ups. PMS and dysmenorrhoea improved in 70% and 85%, respectively with no reported endometrial hyperplasia and rise in Hb (2.5 g on average). MBL became progressively less with time without increased risk of Pelvic infection. A reduction in fibroid size was noted in 55% after 12–36 months and 2% expelled the device in 1–24 weeks. Ninety percent patients were compliant with their HRT after one year, 83%after three years. Major surgical interventions were avoided in 90% with high satisfaction.
Conclusion
Mirena improves compliance of HRT in perimenopausal women suffering with menorrhagia with minimal side effects. It provides contraception, good endometrial protection, reduces MBL (75–100%), improves PMS and dysmenorrhoea, avoids surgical interventions, with continuation of HRT > 90%, 85%, 83%, 73% and 70%, respectively after one, two, three, four and five years.
Posters Poster 1
What effect does the menopause have on women and how do they feel about the care and education they receive?
15th Year Medical Student, School of Medicine, University of Liverpool, Liverpool, UK
2Southport and Ormskirk Hospital NHS Trust, Gynaecology, UK; May Logan Centre, UK
Introduction
Within the UK, it is estimated that 1.5 million women (80%) experience the common menopausal symptoms including hot flushes, night sweats, mood changes and vaginal dryness. The study aims to investigate what menopause symptoms women experience and how this affects their life. Also, it aims to assess access to quality menopause information and the usefulness of menopause clinic at Southport District General Hospital (SDGH).
Methods
Questionnaire made up of 21 questions, consisting of multiple choice and free-text answers, were handed out to new and follow-up patients seen at the SDGH specialist menopause clinic. Patients were asked to read patient information booklet after their appointment and then complete the survey.
Results
Twelve surveys were completed. It was found that 67% were referred by their GPs and the most common symptoms were hot flushes, night sweats, emotional instability and vaginal dryness with 60% surveyed experiencing at least one symptom. Seventy-five percent of patients had experienced vaginal dryness or issues with their pelvic floor or sexual intercourse. Ninety-two percent of patients had changed their behaviour due to symptoms and 60% were affected on more than 20 days a month. Behavioural changes included avoiding sex, spending more time alone due to low mood and changing sleeping habits. Sixty-seven percent of patients were concerned about HRT due to risk of cancer, side effects and anxiety over new medication. Fifty-eight percent of patients of patients waited months before seeking medical help for symptoms and 33% waited years. Barriers to seeking help included being unaware of help available, unaware of menopause symptoms, embarrassment and an unhelpful GP.
Conclusions
Women in the UK experience a range of bothersome menopause symptoms which impact their lives and relationships. Patients lack appropriate education and access to quality menopause resources, leading to a delay in women attending services for help. By bettering menopause education for patients and healthcare professionals, we can improve menopause management and the quality of life of the women affected.
Poster 2
Getting it right from the start – Are we adequately addressing osteoporosis risk in Somali women?
1Pharmacist Consultant, London North West Healthcare University NHS Trust & Imperial College, School of Science & Medicine, UK
2London North West Healthcare University NHS Trust & Imperial College, School of Science & Medicine, UK
3Medical Student, Imperial College, School of Science & Medicine, UK
Introduction
Oestrogens influence skeletal homeostasis during growth and adulthood. HRT is recommended for bone protection in menopausal women between age 50 to 60 years and in POI (NOS 2011); this plans for use of bisphosphonates and other evidence-based bone sparing agents later during the life course. For good bone health calcium and Vitamin D repletion and lifestyle interventions are important. PHE suggests population wide Vitamin D supplementation of 400 iu daily. Bone specialists recommend 800–1000 iu maintenance dose daily, unless deficient/insufficient when an initial higher loading dose maybe required. High risk groups include medical cases, the elderly, pregnancy and breast feeding, dark skin and intentional/non-intentional nutritional deficiencies. We report findings from pre-pilot work undertaken to assess baseline Vitamin D levels in a high risk exemplar group of pregnant women.
Methods
Two sixth-year medical students undertook retrospective data collation using lists generated for Somali women (our high-risk group) who gave birth at a London maternity unit between 2013 and 2017 (n = 249).
Results
Over five years, at least one vitamin D blood test was done within the antenatal period (via hospital or community), in 75 (30.1%) Somali women. It was found that 69% (52) had levels below 50 nmol/l, with 33% (25) classed as deficient and 36% (27) as insufficient status (based on Trust thresholds).
Conclusion
Our study highlights both lack of vitamin D testing in a high-risk group and a worrying level of insufficiency/deficiency status when tested. There is a high prevalence of vitamin D deficiency in pregnant Somali women living in Sweden (Saaf, 2011) and in Somali mothers and their infants living in Norway (Madar 2008). Modgil’s (2010) retrospective study noted high prevalence of Somali children with vitamin D deficiency in the UK. Robust data on the vitamin D status of pregnant Somali women in the UK is lacking. Recent reviews (Colonese, 2015; Nandi, 2016) highlight concerns that effects of Vitamin D on reproduction are not direct but secondary to hypocalcaemia or oestrogen deprivation. Whether oestrogen action is enough for bone protection in compromised vitamin D status needs further study.
Poster 3
Incidence of breast cancer in VVA patients treated with ospemifene and those without any VVA related treatments from a US real world data
1Senior Director, Global Epidemiology & Real World Evidence, Shionogi Inc., Florham Park, NJ, USA
2Senior Medical Director, Women’s Health, Shionogi Limited, London, UK
3Associate Director, Genesis Research LLC, Hoboken, NJ, USA
4VP, EU Medical Affair, Shionogi Limited, London, UK
5VP, US Medical Affair, Shionogi Inc., Florham Park, NJ, USA
Introduction
Ospemifene has been marketed in the USA since 2013 to treat moderate to severe dyspareunia, a symptom of vulvar and vaginal atrophy (VVA) due to menopause. This study used real-world data to estimate the incidence rates of breast cancer in VVA patients without a history of breast cancer treated with ospemifene, and in similar patients without any VVA related treatment.
Methods
VVA patients without a history of breast cancer were identified from 2013 to 2017 US MarketScan Commercial and Medicare Supplemental insurance claims database. Those received ≥1 ospemifene after the first VVA diagnosis were considered as treated subjects and those without any VVA related treatment after the first VVA diagnosis were considered as untreated subjects. The first dispensing of ospemifene was the index date for the treated subjects, and the first diagnosis of VVA was the index date for the untreated subjects. All subjects were required to have ≥1 year baseline data before the index date and ≥1 year follow-up data after the index date. Breast cancer after the index date was identified using the diagnosis codes combined with chemotherapy or surgical procedures and considered as incidence case. Incidence rate, relative risk (RR) and their 95% confidence intervals (CI) were calculated for all study subjects, and for a subset of subjects after matching one treated subject with two untreated subjects on age, year of index date, Charlson Comorbidity Index score, geographic region, and follow-up duration. A total of 2528 ospemifene users and 118,623 untreated VVA patients met the study inclusion and exclusion criteria. The treated subjects were supplied with ospemifene for an average of 273 days (SD = 280). Average follow-up time was 803 days (SD = 307) for treated and 992 days (SD = 493) for untreated. Seven treated and 927 untreated subjects had breast cancer after the index date. The breast cancer incidence rate per 1000 person-year was 1.3 (95% CI: 0.5–2.6) for treated subjects and 2.9 (95% CI: 2.7–3.1) for untreated subjects (RR= 0.45, 95%CI: 0.19–0.84).
Results
After applying the matching criteria, 4 of 2005 treated subjects and 14 of 4010 untreated subjects had breast cancer after the index date. The incidence rate per 1000 person–year was 0.9 (95%CI: 0.2–2.3) for treated subjects and 1.6 (95%CI: 0.9–2.7) for matched untreated subjects (RR = 0.56, 95%CI: 0.22–0.85).
Conclusions
The study did not show an increased risk of breast cancer in ospemifene users comparing to untreated VVA patients, even after matching treated with untreated.
Poster 4
Incidence of venous thromboembolism (VTE) among postmenopausal women prescribed ospemifene, selective oestrogen receptor modulators (SERM), or untreated vulvar and vaginal atrophy
1Senior Director, Global Epidemiology and Real World Evidence, Shionogi Inc., Florham Park, NJ, USA
2Senior Research Leader and Executive Director, Epidemiology, Evidera, Boston, MA, USA
3Biometrician, Shionogi & Co. LTD, Osaka, Japan
4Research Associate III – Real World Evidence, Evidera, London, UK
5Vice President, Head of Drug Safety Europe, Shionogi Europe, London, UK
6Safety Physician, Consultant, Shionogi Europe, London, UK
Introduction
Ospemifene is a non-steroidal selective oestrogen receptor modulator (SERM) for moderate to severe dyspareunia, a symptom of vulvar and vaginal atrophy (VVA) due to menopause. An ongoing EU post-authorisation safety study estimated the incidence of venous thromboembolism (VTE) in a cohort of postmenopausal women prescribed ospemifene, other SERM (raloxifene, bazedoxifene, or tamoxifen, for non-cancer indications), or untreated VVA.
Methods
Using US MarketScan Commercial and Medicare Supplemental claims database from 1 May 2013 to 31 December 2017, incident cases of VTE among new users of ospemifene, other SERM, or untreated VVA were identified. The incidence rate and 95% confidence interval (CI) of VTE during the first continuous course of treatment (or continuous untreated time for the untreated for VVA cohort) were calculated for each cohort overall and by age group Adjusted Cox models compared risk of VTE between ospemifene and each comparator group.
Results
The incidence per 1000 person–years and 95% CI of VTE were 3.7 (1.7–7.1), 11.5 (8.9–14.6) and 11.3 (10.8–11.7) in the ospemifene (8188 users), other SERM (11,777 users) and untreated VVA (220,242 women) cohorts, respectively. When stratified by age, incidence per 1000 person–years and 95% CI of VTE among women aged ≤65 years were 3.5 (1.5–6.9) for ospemifene, 8.6 (5.9–12.0) for other SERM, and 8.2 (7.8–8.7) for untreated VVA patients. Parallel results for age >65 years were 8.4 (0.2–47.0) for ospemifene, 16.3 (10.9–23.4) for other SERM, and 19.4 (18.3–20.7) for untreated VVA. Adjusted Cox models confirmed the lower VTE rate in ospemifene vs. other SERM (hazard ratio [HR] 0.44; 95% CI 0.20–0.96) and vs. untreated VVA (0.42; 0.21–0.85) in the younger group. The older group had too few events for analysis.
Conclusions
Patients treated with ospemifene had a lower incidence of VTE than other SERM users and untreated VVA patients. This early analysis of an ongoing study suggests a favourable safety profile for ospemifene with respect to VTE.
Poster 5
“It’s like we don’t belong here”: The sexual and reproductive health needs of cis-gendered women living with HIV aged ≥40 years attending a London HIV clinic
1Locum Consultant Sexual & Reproductive Health, Barts Health NHS Trust, London, UK
2Consultant GUM/HIV, Central & North-West London NHS Trust, London, UK
3Consultant Public Health/Consultant Sexual & Reproductive Health, Public Health England/Homerton University Hospital NHS Trust, London, UK
4Patient Representative, Central & North-West London NHS Trust, London, UK
5Clinical Research Fellow/Honorary Consultant HIV, Institute for Global Health UCL/Central & North-West London NHS Trust, London, UK
Introduction
There are increasing numbers of women aged ≥40 years living with HIV in the UK. Not enough is known about the sexual and reproductive health (SRH) needs of women living with HIV (WLHIV) in this age group. We explored the SRH needs of cis-gendered WLHIV aged ≥40 years attending our clinic (including current provision of services), particularly focusing on their menopausal health needs.
Methods
We conducted a mixed-methods health needs assessment comprising: (1) retrospective review of routine clinic data from a random sample of 50 WLHIV aged ≥40 years attending clinics between 1 July 2017 and 31 December 2017; (2) multi-disciplinary stakeholder meetings with clinic staff and experts; (3) patient engagement event where WLHIV were invited to share their experiences and suggestions.
Results
Among the 50 notes reviewed, mean age of WLHIV aged ≥40 attending our clinic was 50 years; 66% were black African. Documentation on both SRH and comorbidity screening was lacking (Table 1).
WLHIV attending the engagement event described the clinic environment as not inclusive of women. Their main health concerns included fertility, sexual function and menopause; however, most women felt that these areas of their SRH were ignored.
Conclusions
Increased awareness of the effects of reproductive ageing on the health and quality of life of WLHIV is important. Our stakeholder group acknowledged that SRH needs of WLHIV aged ≥40 were overlooked in our service. In collaboration with this group, we have established a clear plan to address the needs of this group and reduce health inequalities.
Documentation of sexual and reproductive health assessment and comorbidity screening in clinical records among WLHIV aged ≥40.
Poster 6
A service development to improve patient and general practitioner access to a regional specialist menopause service
1ST6 Obstetrics & Gynaecology, Belfast Trust Health & Social Care Trust, London, UK
2Associate Specialist Gynaecology, Belfast Health & Social Care Trust, London, UK
3Consultant Gynaecologist, Belfast Health and Social Care Trust, London, UK
Introduction
Life expectancy has increased for women in the UK; therefore, women are spending at least a third of their lifetime postmenopausal.1 British Menopause Society consensus statement 2016 suggests that all women should have access to advice so that they can make informed decisions about diet, lifestyle and treatment options to optimise their menopause transition and postmenopausal health.2 There is an expectation that more women will want to consider commencing HRT following media spotlight, including a recent BBC Breakfast menopause themed week. Most patients commencing HRT are managed by a general practitioner (GP). However, many non-complex cases are sent to specialist care leading to resource strain. In order to improve patient experience and decrease waiting times, we trialled a written advice service.
Methods
Between January and April 2019, enhanced triage was carried out on new HRT clinic referrals. Fifty-nine (23%) referrals were deemed appropriate for individualised written advice response letters to the GP and patient, in lieu of offering a consultation. This included a 2-question acceptability survey for GP and follow-up telephone survey with the patient.
Results
Forty-two GP responses were received. Ninety-eight percent of GPs were happy to have received a letter of advice as alternative to an appointment for their patient. Ninety-five percent of GPs would like to have the option to choose either an advice service or traditional consultation for future referrals. Seventy-seven percent of patients were happy with receiving a response letter and 23% would have preferred a face-to face consultation. The mean patient travel distance saved was 16 miles (1–60).
Conclusions
The pilot of individualised written advice response letters proved acceptable to both patients and GPs, with interest in a formal service being available. This has the potential to reduce waiting times and enhance patient experience.
In addition, this system improves education and confidence in HRT prescribing for GP colleagues as each letter can be a teaching opportunity.
References
Poster 7
Menopause at work: A survey to look at the impact of menopausal and perimenopausal symptoms upon women in the workplace
1Menopause Clinic, Newson Health, Stratford upon Avon, London, UK
2Newson Health, Stratford upon Avon, London, UK
Introduction
In the UK, 4.3 million women aged over 50 are currently in employment. Around 80% of women have symptoms due to the menopause and 25% have severe symptoms which detrimentally affect their family, home and work life. Research has shown that around 10% of women actually stop working.
Methods
We devised a questionnaire to find out more about what impact menopausal symptoms had on performance at work, sickness rate, reducing hours at work. The questionnaire was sent out via social media to women experiencing menopausal and perimenopausal symptoms.
Results
The questionnaire was completed by 1132 women. Of these, 93% felt their menopausal symptoms were having a negative impact on their work, with a deterioration in work performance being noted by colleagues in 53% of respondents. Nine percent had to undergo a disciplinary procedure as a result of poor performance at work. Fifty-one percent had time off due to menopausal symptoms and 19% were off for more than 8 weeks. Thirty-seven percent had a sick certificate and 52% of the sick certificates stated anxiety/stress as a cause with only 7% stating menopause as a reason for sickness. Thirty-one percent had thought about reducing their hours and 32% had thought about leaving their job as a result of their symptoms and 51% had reduced their hours at work. Seventy-one percent had received some sort of treatment from a doctor or healthcare professional. Only 14.5% had received any advice or support about their symptoms from their workplace. 9.2% of respondents’ workplaces offered menopause awareness sessions, 10% offered menopause discussion groups, 4.2% offered training for staff about the menopause and 75% offered nothing.
Conclusions
There is a huge impact of menopausal symptoms upon women in the workplace in terms of performance, sickness rate, and ability to cope with their current job. The reasons for sickness are usually classified as due to anxiety or stress. There is a general lack of support for these women in the workplace.