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Menopause

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MPs told NHS should give meno check at 45

77 replies

PalatineHill · 12/10/2022 08:13

www.bbc.co.uk/news/health-63212957

Sounds like a great idea. (Though I’ve never heard of anyone being offered a health check at 40). Would you welcome this? If so.. write to your MP!
The Women’s Health Strategy was the UK government’s first ever attempt to help women across so many key health issues but seems to have been completely ignored since the arrival of Truss and Coffey. Worth mentioning that to your MP too to put pressure on the government to carry out its aims. Truss and Coffey weren’t voted in so they have no mandate for dropping it.
I think we all know by now that if we don’t ask, we don’t get. And too often, when we do ask, we still don’t get. It doesn’t have to be like this.

OP posts:
PalatineHill · 12/10/2022 08:48

Loads of rural GPs have no Well woman clinic nor any women’s health specialist at the practice. And various areas of the country don’t even have a hospital menopause clinic service to refer complex cases to, in their whole region covering hundreds of thousands of patients.

So lots and lots of women are completely fucked unless they are lucky and their symptoms happen to respond to the generic first line GP treatment- if they can even get a GP to listen to them in the first place to let them try what little is available- or unless they can pay privately. All of which is totally unacceptable.

Hence me saying- write to your MP. They need to understand that there are votes in this issue.

OP posts:
VinoDino · 12/10/2022 08:53

I'm 40 and in Scotland, can I get a health check? I really think I'm peri-menopausal.

I'm having brain fog, I've always had weight around my middle but the last couple of years two stone has gone on and it's all around my tummy, my sleep is bad and I'm starting to have random periods again whereas they stopped with the contraceptive implant I've had for years. I've never had children.

Hbh17 · 12/10/2022 08:56

Sounds like an utter waste of public money, as most people won't need it. I wasn't having periods at 45, due to PCOS, but they started again at 48 and continued regularly until I was 56. I haven't needed to see a doctor about any of this since my PCOS diagnosis (age 35). I know I am now menopausal as my periods have finally stopped - of course, I am delighted and I'm just cracking on. If, at any point, I had felt the need to see a doctor then I would have made an appointment - which is an option currently open to everyone.
We do not need a patronising NHS offering all sorts of random checks for healthy people.

Tillow4ever · 12/10/2022 09:25

Heilalala · 12/10/2022 08:17

Everyone is offered a health check at 40 a far as I'm aware - we certainly were.

I wasn't offered a health check at 40 - I'm about to turn 43, so it was pre-covid (I.e. no excuse for it being missed or delayed).

JinglingHellsBells · 12/10/2022 09:30

If nothing else, it ought to raise the profile of the menopause and also make GPs stop prescribing incorrect treatments (ADs are mentioned, as one.)

I was disappointed to hear on Radio 4 this morning, a discussion around 'bio-identical' HRT when it's been called 'body-identical' now for years by specialists, to distinguish it from the compounded, unlicensed sort.

The interview focused on how some women are not allowed to have bio/body identical but in reality I think this only applies to some regions in Scotland (and the other side of the coin is that some treatments are available to the Scots and not in England! Such as the newest and best treatment for osteoporosis.)

I agree that what is needed is mandatory training for specialist nurses or GPs.
Most women do not need to see a GP for menopause or HRT, as a specialist nurse could prescribe. GPs could be there to refer for tests etc or a 2nd opinion.

as a BTW I was never offered a health check at 40. And the reality is you can do them at home anyway- buy a blood pressure monitor, weigh yourself, do a blood glucose test if you have a family history of diabetes, or see your GP if you have symptoms.

cptartapp · 12/10/2022 09:31

Hbh17 · 12/10/2022 08:56

Sounds like an utter waste of public money, as most people won't need it. I wasn't having periods at 45, due to PCOS, but they started again at 48 and continued regularly until I was 56. I haven't needed to see a doctor about any of this since my PCOS diagnosis (age 35). I know I am now menopausal as my periods have finally stopped - of course, I am delighted and I'm just cracking on. If, at any point, I had felt the need to see a doctor then I would have made an appointment - which is an option currently open to everyone.
We do not need a patronising NHS offering all sorts of random checks for healthy people.

If I do twenty of these random checks this week, I can guarantee I will find issues of concern for about five. So 25%. It's usually BP, or sometimes raised cholesterol, atrial fibrillation, diabetes/or pre diabetes, thyroid problems etc.
So although they are a tick box exercise which brings money into the practice to put the lights on and pay my salary, it saves the NHS a packet in the long term if these problems are addressed/treated asap.
Not to mention the personal cost to the individual for example, of preventing a stroke.

JinglingHellsBells · 12/10/2022 09:39

@PalatineHill why do you think it's just rural areas that are short changed? I'm in a large town in the SE (commuter belt) and we have no clinics are well woman clinics.

JinglingHellsBells · 12/10/2022 09:41

@cptartapp But not all GPs do them! Neither me nor DH have ever had one with the same practice for 30 years.

And as I said, people can do some of those checks anyway at home or by paying at a pharmacy.

cptartapp · 12/10/2022 09:45

JinglingHellsBells · 12/10/2022 09:41

@cptartapp But not all GPs do them! Neither me nor DH have ever had one with the same practice for 30 years.

And as I said, people can do some of those checks anyway at home or by paying at a pharmacy.

You're right they don't. Although we do them if patients ask and haven't had one within 5 years. To be honest they're low priority at the minute, clinics are rammed with diabetics, smears, vaccinations etc.
Certainly I would check your own BP. Bloods which surprisingly often throw up asymptomatic issues, more difficult.

Prestissimo · 12/10/2022 10:14

Well I'm a GP and a woman on HRT and sadly I agree these are a tick-box suggestion and probably a waste of money and time. This is the typical sort of thing that Government reports suggest and they are implemented without any consideration of why menopause care is so poor in the first place.

Many GPs feel poorly-equipped to have these conversations with women, partly because for the last 20years (that I've been practising) the evidence and guidelines have been wildly conflicting and so doctors feel overwhelmed and out-of-date. It's not good enough - I spend a lot of my time banging my head on my desk as my colleagues ask me questions - it's really not that hard! However, I do this a lot. Many of my colleagues do not. And unfortunately that means that you get some very skilled drs and some who can barely spell HRT because they are intimidated by the thought of it. They are skilled in other areas, maybe (my diabetes care is certainly not what it once was, for example). General Practice is hugely more complicated than it used to be, hospitals are seeing and monitoring patients less and less, and our average patient has more long-term conditions and more medications than ever before. And with increasing pressures on primary care education has sadly taken a very back seat. All of our local education meetings (previously a half day/month) have been cancelled since covid and there is no prospect of getting them back. With many GPs routinely working 12-13 hour days the reality is that most don't want or don't have capacity to spend days off or holidays doing courses - they're trying to have some kind of life. (And of course many drs spend their days off doing practice admin so they're already working). This isn't good for patients (or doctors actually - it's much nicer going to work when you feel like you know something).

Similarly we hold an email inbox of patients waiting for appointments, but we are absolutely mad busy at the moment. 200, 300 requests for appointments every day. We are working as hard as we can but unfortunately there are health issues that are on-the-day urgent and then there are the things that can wait. Menopausal symptoms wait. We get to them as soon as we can, but I'm not blind to the fact that many women already hold off as long as they can and are (understandably) thoroughly pissed off when it's then another 3-4 weeks before they get an appointment. If we're struggling to control symptoms and refer to gynae that's a 1year+ wait locally. We're actually doing some work to set up a menopause pathway within the practice to improve access, assessment and treatment for these women. But inviting every 45yo woman in won't make the symptomatic ones get seen any quicker.

We need to improve all the systems so that all women feel able to come forward when they have troubling symptoms, whether related to the menopause or anything else, and feel that they will be properly and respectfully listened to, skilfully assessed and appropriately treated, all in a timely manner. We are some way from that.

The reason that people are offered a cardiovascular health check at 40 btw is because there is good evidence that screening and intervention at this stage will save money (and lives) in the long-term. Unfortunately, miserable as the menopause can be, in purely health economics terms it's unlikely to cut the mustard as a priority for proactive care. This is a soundbite from government I'm afraid and is unlikely to actually improve anything without the rest of our broken system being fixed.

JinglingHellsBells · 12/10/2022 11:09

I can see your point @Prestissimo BUT I also get tired of GPs complaining about their hours. They are professionals and many other professionals do long hours.

In other professions, international travel cutting into weekends is the norm, for many employees on the same (or lower ) salary than a GP.

I have friends, and sons/ daughters of friends who are drs, but others are in the City, in commerce, and for the same 6 figure salaries as GPs. They work 12 hr days as routine. They also find time for CPD.

I think it is appalling that there is not (in many cases) 1 dr in a practice who can't give up a day in a year to do a British Menopause Society training course on HRT. They are often online and cost around £100. There is also the annual BMS conference in London which is attended by the top meno experts in the country.
These events ought to be attended by GPs or they ought to do an online training course.

This is what's letting women down!

Prestissimo · 12/10/2022 11:33

I take your point @JinglingHellsBells but I would argue that the intensity of GP work as well as the hours themselves is what is currently so challenging and what is different to other long-hours professions. No one goes into medicine expecting short hours (or if they do they're disillusioned pretty quickly). Even hospital Consultant get admin sessions within their working week - my admin is done when I can fit it in. Making that number of (potentially life and death or at least life-changing) decisions on a daily basis is not good for the brain. I've been doing the job for 20 years and there are now days when I get home from work and I'm literally fit for nothing. That never happened before, and as I get more experienced it should be getting easier. The job is very different now to when I started, and we would have a relatively light couple of hours at lunchtime to eat and do admin and home visits. Ten years ago I could go home for my lunch. Nowadays it's much more likely that I eat at my desk while simultaneous reading hospital letters or emailing patients or writing a child protection report.

It's not an excuse for poor levels of CPD (and I didn't want this to become the usual debate about GP hours) but it is a reason. And it feeds into needing a systems approach to fixing something rather than the sticking plaster 'offer everyone a menopause review'. We're coming at this after a period of two years where literally guidelines would change wholesale and overnight, with constant reorganisation of not only the practice (often with 24hours' notice) but also the services that we refer into. It's been so nice over the last six months to get back to learning about stuff other than bloody covid and it's ramifications. GPs are - obviously - generalists and so there's a lot for us to keep on top of. I agree that menopause is important but so are lots of other things.

One doctor in a practice doing the BMS course isn't going to cut it. I'm doing a menopause update course next week but that doesn't help my colleagues become experts. Whereas previously we would have had protected education time for me to do cascade training that's now been cancelled. I'm already pretty good at it, actually, but I can't see all the women asking for appointments about menopause and HRT - I'd do nothing else!

TheOGCCL · 12/10/2022 11:59

I had two health checks at 40, one at a local pharmacy and one at the GP.

I think the idea behind this is that plenty of women do not relate their symptoms to being potentially peri/menopausal. There’s so much ignorance. Tipping women off at least gives them an opportunity to do some research and take charge of their health, rather than thinking they are depressed or any number of other things peri can be mistaken for. I think in particular women do not grasp how an ostensibly physical transition can have such a mental effect.

Prestissimo · 12/10/2022 12:19

That's certainly true @TheOGCCL but research shows that these women may be better treated with antidepressants anyway. Not always but certainly sometimes. ADs can also help treat other menopausal symptoms like hot flushes, although usually wouldn't be used first-line for that. The problem comes when ADs don't work of course - and you cycle through various different ones instead of thinking "I wonder if this is menopause".

I agree more public information would be helpful - I often see women who struggle with vaginal dryness for years because they didn't know we could easily and safely treat it and they've not had flushes so never bothered coming about their menopausal symptoms. They're some of my favourite consultations because we can so easily make a massive difference to women's quality of life.

Unfortunately though with things as they are currently we don't have the time or the staff to be doing 'here's some things to look out for - please come and see us if you have a problem' consultations. That could be done as a public health campaign (as proven by Davina, actually) but as we've seen with energy saving measures this may not be the right government for widespread information sharing...

JinglingHellsBells · 12/10/2022 12:51

@Prestissimo I often think that the GPs who come to a forum when they say they are so busy are not proving their point very well.

No one I know who is earning a 6-figure sum (which is what is available to some GPs), spends time on social media during a working day.

GPs get excellent pensions paid for by tax payers, they have a good income, and sometimes they come over as lacking perspective on other professions' working hours.

I am sure there is room for change-management within the NHS, but equally, I'd expect a committed GP to do some CPD even if it meant in their own time.

JinglingHellsBells · 12/10/2022 12:55

Unfortunately though with things as they are currently we don't have the time or the staff to be doing 'here's some things to look out for - please come and see us if you have a problem' consultations.

Why can't a GP practice do something as simple as leaving handouts in the waiting rooms or posters on the walls?

Can't GPs take control of this type of situation and manage it within the practice?

I used to do some work for a charity and we left info in surgeries of signs that someone may have the condition.

JinglingHellsBells · 12/10/2022 12:57

One doctor in a practice doing the BMS course isn't going to cut it.

I don't get this.

One dr is better than none.

If at least one GP in each practice was assigned as a meno expert, it would be a start.

This is something that #MakeMenopauseMatter has campaigned for , for a long time.

Meseekslookatme · 12/10/2022 12:58

Heilalala · 12/10/2022 08:17

Everyone is offered a health check at 40 a far as I'm aware - we certainly were.

Still waiting at 43 for mine 🙄

GinIronic · 12/10/2022 13:05

It’s a waste of public funds. This will give the “worried well” another excuse to fill up waiting rooms and appointments. The government wants to appear to be addressing this issue because apparently it’s now acceptable to talk about the menopause. Tick this box and move on.

deathofthesnark · 12/10/2022 13:06

Heilalala · 12/10/2022 08:17

Everyone is offered a health check at 40 a far as I'm aware - we certainly were.

I'm 51 and have never been offered a health check

MarshaBradyo · 12/10/2022 13:10

I’ve had two health checks for some reason one early 40s other late - all good fortunately so not due to any issues that needed more attention

Peri menopause seems self determined atm - at our GP you can call up and HRT is given on request and not much more

BooseysMom · 12/10/2022 13:13

Meseekslookatme · 12/10/2022 12:58

Still waiting at 43 for mine 🙄

Same here although I had bloods, etc done when I requested it due to worsening peri symptoms. I questioned the fact I haven't been called for a mammogram yet and I'm 50 with a mum who had breast cancer at 60. They told me it will be within 3 years and to check myself regularly. 3 years!!

KnottyKnitting · 12/10/2022 13:22

Is this going to involve checks by people who actually know what they are bloody talking about as opposed to some young male GP who refuses to give you HRT because "it gives you breast cancer."

Prestissimo · 12/10/2022 13:26

@JinglingHellsBells I'm not sure why my having a day off in the week invalidates my knowledge of GPs' working hours. Not that it's necessarily your business but I've been writing up some (mandatory) annual GP appraisals this morning and have a training event for my Parent Governor role this afternoon. I hope that's okay?

I agree with you that ideally each practice should have someone who is expert in menopausal management. More than one. I'm an advocate of better care and know that many GPs are currently hugely frustrated with the limitations on what we can offer. I'm simply saying that a) there are many reasons that this is not the case, b) with current workforce pressures and shortages that isn't likely to change soon and c) that introducing a one-size-fits-all review when a woman is 45 is not going to fix that.

PragmaticWench · 12/10/2022 13:27

Health check at 40?! Only for men in my local area, none of my female friends or I have been offered one but all the men have. 🙄

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