Abstract
Historically it was the gynaecologist in the UK, who offered support to women at the time of the menopause, usually in the form of a prescription for hormone replacement therapy (HRT) and often primarily for treatment of short and intermediate term symptoms. Women were seen in the general Gynaecology Clinic and consultations were often brief. In the past 10 years however, as more and varied treatments have become available and as the professional roles of other colleagues have evolved, it is now increasingly common to see the primary care doctor, nurses including the practice nurse or indeed other health-care professionals such as pharmacists, counsellors and dieticians seeing and advising women, alongside the development of specialist menopause clinics led by gynaecologists. The multidisciplinary approach can enhance the quality of care, while at the same time taking into account other aspects such as service efficiency, safety, continuity and timeliness of care.
As we increasingly recognize the menopausal years as a crucial time for health promotion, advice has become broader and now encompasses all aspects of healthy living including dietary advice, lifestyle management and disease prevention as well as symptom control, medication management and prevention of longer term sequelae of estrogen deficiency. Following a comprehensive holistic health history, the menopause consultation has become a time to discuss a variety of health issues, not just relief of troublesome menopausal symptoms.
In addition, we have seen the popularity of HRT use among women fluctuate alongside media coverage which is often negative. One positive effect of this, however, is that women are increasingly seeking a more in depth discussion about the safety of HRT on an individual basis. In addition, many women are turning initially to therapies other than HRT with little professional advice. 1 Today's patient tends to be more knowledgeable with information from peers, the Internet and media but unfortunately the information is often either superficial or too complex to be of value to an individual patient. There is room for professionals of all groups to better educate women about menopause, HRT and other therapy options. This knowledge empowers women to make informed choices about how best to manage their own menopause and the years beyond.
Formal doctors' training programmes have been developed, such as the RCOG Special Skills module for gynaecologists and the Faculty of Sexual and Reproductive Health courses for other doctors, but the needs of other health professionals have gone broadly unmet, except for ad hoc study days and journal articles. There has been a paucity of accredited post-registration, education programmes and a lack of accountability in terms of competence for non-medical practitioners working in menopause.
The role of nurses in particular has developed over a long period of time and a ‘nurse’ working in menopause might be a health-care support worker, welcoming women and assisting a doctor with examinations, such as pelvic and vaginal examinations, or a Nurse Consultant assessing and advising women independently, prescribing where appropriate and investigating abnormal pathology, with many levels of expertise in between. With this wide spectrum of responsibility, there is a need for nurses to be professionally accountable for their practice and competent in the work they choose to do. Similarly, medical and other colleagues need to have confidence that nurses have the necessary attitudes, skills and knowledge to work at a given level of responsibility. The Royal College of Nursing Competence Framework for nurses and health-care support workers working in menopause is a step towards the profession themselves taking responsibility for clinical practice within this field and enables nurses and employers to identify an appropriate level of practice for a particular nurse, given their knowledge and clinical skills. It offers nurses a pathway towards expert practice and guidance within the specialist field of menopause. 2
The Royal College of Obstetricians and Gynaecologist Standards for Gynaecology support multidisciplinary working 3 and recognize the need for non-medical health professionals to be ‘appropriately trained’ (p. 35). For nurses, education programmes, which are both professionally and academically accredited, are now available at both a foundation level and a more advanced level. However in the current climate, there are issues relating to funding and availability of study leave for those nurses wanting to complete such courses.
Within the current climate of National Health Service funding, one can never be sure that current service provision will continue. Multidisciplinary Specialist Menopause Clinics, usually led by a gynaecologist, meet a real clinical need for women with complicating factors, those with special clinical need such as the younger women or those with cancer, but just as importantly they are a source of education to other professionals, cascading clinical excellence by example and offering training and skills-based resources. Nurses and other health professionals can be an integral part of this cascade of education, which ends eventually with women themselves being better informed and empowered to make appropriate choices for their future health.
Competing interests
None declared.