Abstract
It is well known that the menopause represents a significant phase of an individual’s life. Within the community setting, menopause care is mainly delivered by GPs and nurses who have undertaken the BMS accreditation. Most people reading this journal article will already have a special interest in the delivery of menopause care, as well as advanced training. It must be acknowledged that the delivery of primary care services is changing and will continue to change. GPs are likely to have a more supervisory role in the future, given that healthcare within primary care is continuing to be delivered by a variety of non-medical professionals. It is therefore vital that those supervising, as well as those seeking supervision, are adequately supported. More integrated collaboration between the primary–secondary care interface is essential.
The transition to menopause is an opportunity to risk assess an individual for wider health considerations including mental health, bone health, and cardiovascular health. It is therefore vital that primary care clinicians collaborate with specialists and consider a holistic approach that ensures all aspects of an individual’s health during this transitional period are considered. There is still variation in menopause-related care for women who have had a previous cancer. More collaborative working locally and nationally between colleagues in breast surgery, cardiology, neurology, and haematology is required, even if through advice and guidance channels. Professionals from these medical backgrounds also need to be further supported to integrate with primary care to deliver menopause-related care.
Timely and accessible advice and guidance from a healthcare professional with expertise in menopause care would be extremely helpful in reducing delays to care. Initiatives such as weekly online drop-in sessions run by a Menopause Specialist for primary care teams to discuss cases and themes and learn from each other are being very well received in some areas. In addition, the introduction of pilot women’s health hubs in some parts of the country has already been a very helpful start in delivering high-quality menopause care, and it is hoped that this type of service will continue.
One of the major challenges in delivering menopause care lies in the knowledge gap among the various healthcare professionals. Many primary care clinicians have limited training in menopause management, unless of course they have completed the BMS certification in Menopause care or attended other authoritative courses or meetings. To bridge this gap, educational programs and resources focused specifically on perimenopause and menopause management are important. Educational events including online webinars are a useful way to challenge misinformation as well as promote high quality and evidence-based advice. Ideally, the delivery of these sessions from a GP with a special interest in the menopause would be helpful as they would also have insight into the challenges that primary care clinicians will face with regard to menopause care.
The perceived societal stigma associated with the menopause is well known and can have a significant influence in the delivery of care. Some individuals feel embarrassed or uncomfortable discussing menopausal symptoms such as changes in sexual health. This silence can lead to underreporting of symptoms, resulting in missed opportunities for intervention and support. General practitioners and other professionals delivering menopause care must adopt an open atmosphere where women feel empowered to discuss their experiences. Encouraging open dialogue is essential for ensuring that patients receive the necessary support and treatment, but this can be difficult given the time constraints in a primary care consultation. Patients should be encouraged to use a symptom diary as part of the consultation to facilitate discussion.
Empowering patients with knowledge about the menopause is another crucial aspect of care. It is well known that many individuals enter the menopause with limited understanding of what to expect. The experiences of the perimenopause and menopause clearly vary between individuals with regard to symptomatology and its impact on quality of life due to various factors. This variability necessitates adoption of an individualised approach to care to offer tailored treatments. By taking into consideration cultural sensitivity, for example, we can explore and understand the specific needs and preferences of each patient. Promoting self-advocacy is important.
Whilst hormone replacement therapy may be suitable and acceptable to some individuals, this may not be the case for all. Some may prefer alternative therapies such as herbal supplements, acupuncture, lifestyle changes, or cognitive behavioural therapy. It is therefore important that primary care clinicians are familiar with these alternatives and feel well equipped in discussing them. To provide holistic care, practices need to establish strong support networks and resources for women, including directories of specialists, support groups, and reliable patient information outlets. Working closely with the patient and public group from each surgery may be a helpful start in understanding how menopause care can be improved within each surgery. Practitioners must stay informed about the latest research, potential benefits, and risks associated with various treatment options to guide their patients effectively. Ongoing education is important.
Recommendations to improve menopause care in General Practice are as follows: • Discuss patient cases with other clinicians in your surgery as part of an MDT group for further advice. • Familiarise yourself with the resources on the BMS website, in particular, BMS Tools for Clinicians, consensus statements, and guidelines. • Encourage personalised care plans for patients who have undergone the menopause to incorporate a more holistic approach and to include risk assessment of osteoporosis and heart disease. • Liaise closely with your local patient and public group to understand and explore ways in which menopause care can be improved within your local area. • Attend the BMS conference and meet other professionals who may also be practicing in your local area to further enhance post reproductive health. • Be aware of local mental health services that may also offer women further support. • Encourage patients to participate in any ongoing research studies with regard to post reproductive health. • Consider completing the BMS menopause qualification, ‘The BMS Management of the Menopause certificate’ if you haven’t already. • Print off infographics from the BMS website that can be used as part of decision making. • Consider using an electronic template for the assessment of menopause-related symptoms and subsequent management. • Ensure patients are aware of their rights within the workplace with regard to menopause-related symptoms. • Consider using health coaching services to enable individuals to achieve their own health goals in relation to the menopause. • Ensure staff in your practice are aware of the cultural considerations that may affect access to menopause care. • Offer information sessions for the staff within your surgery – they, their partners, and their relatives will be, or will become, menopausal too!
Conclusion
As the population ages and more individuals seek support for menopausal symptoms, it is imperative that healthcare providers prioritise menopause training, foster open communication, and promote a holistic approach to care. As awareness and understanding of the menopause continues to grow, it is essential that general practices evolve to meet the needs of their patients, ultimately enhancing the health and well-being of individuals during this pivotal stage of their lives. The transition to menopause is an excellent opportunity for primary care clinicians to consider health promotion and illness prevention for future health.