Menopause: Specialists needed to reduce contradictory advice

Women receive contradictory medical advice on the menopause and a specialist is needed in every health board, campaigners claim.

"It got to the stage where I was so desperate I paid for a private consultation," said Lisa Nicholls.

She was later referred to a specialist as she lives in one of three Welsh health board areas which offer one.

The Welsh government said every health board should provide a full range of menopause services and support.

Ms Nicholls, 52, from Newport, said her own menopausal symptoms left her feeling she was losing her mind.

"I couldn't remember people's names, or what I did yesterday," she said. "I'd have conversations with people and I'd be like. "Did we really have that discussion?"

"It really affected my work life to the point where I gave up my job because I just didn't feel that I could perform.

"At the time I was in a senior position and I just felt like I'd lost my confidence."

She now sits on the Welsh government's menopause task and finish group, representing the charity, Fair Treatment for the Women of Wales, and wants menopause and hormone discussions to be as common as breast or cervical screening.

"I would like to see a woman getting to a certain age - say 45 - and a healthcare professional says, 'OK, you're 45 now, your hormones are going to be declining, let's have a chat about how that might be affecting you, and if you can tick any of these boxes.'"

"It is really as simple as a checklist in terms of what you're experiencing.

"Because it will help with their bone health, heart health - we might see improvements where women are perhaps not getting dementia, Alzheimer's.

"And it's a lot cheaper than treating a woman who's 65 with a broken hip, replacement knees, heart issues and everything else that goes with it.

"Every woman in Wales, in every health board needs access to either really good GP services who specialise in the menopause, or a menopause specialist clinic."

Last week, the Welsh government published a quality statement on women's health, stating it was of "paramount importance" for health board services to reflect women's needs, adding that menopause was one of those which required "significant attention".

It also stated the need to provide care "as close as possible to home without significant waits".

Likewise, National Institute for Clinical Excellence (NICE) guidance says women should be referred to menopause specialists if treatments don't improve symptoms or troublesome side effects continue.

Referrals can also be considered for those with a higher risk of breast cancer, or where the most suitable treatment isn't clear.

Dr Rowena Christmas, a GP in the Wye Valley and chair of the Royal College of GPs in Wales, said that menopause was covered in medical school training, as well as the additional three year GP-training, then again during their ongoing professional development.

"The training resources are excellent and we are talking about it a lot as a profession," she said.

"The media programmes have been really good to heighten awareness for patients and they're bringing that into our surgery."

Dr Christmas agreed doctors need to be thinking of menopause as a possible diagnosis for women of any age experiencing relevant symptoms.

"But on the flip side you also need to be considering whether they could have a thyroid problem or whether there's something sinister causing the night sweats," she added.

"So we need to think big, broad picture and not miss anything else - but absolutely menopause needs to be up there as a possible diagnosis."

She said that larger GP practices will have scope for some to specialise in certain areas. Her own practice has a menopause specialist who has studied for a Masters in the subject.

"Menopause can be devastating for some women - other women will go through it with advice and support and not need any treatment at all.

"And so for those women who are having a difficult time it really is essential that you find a GP that you feel comfortable talking through the issues and you get treatment because it is extremely effective."

Members of the Cardiff-based choir, Only Menopause Aloud, agreed that access to greater support is needed, as symptoms differ from woman to woman.

Clare Adams felt very anxious, with a foggy brain and unable to get her words out. "My GP said I was either depressed and could be put on anti-depressants, or else try HRT - HRT did the trick," said the 58 year old.

Whereas 68-year-old Sandy Alton's hot flushes would leave her feeling totally drained.

"I would feel ill at first, almost as though I was going to faint and then suddenly this boiler would go off inside me and the heat would rise up from my stomach."

Sue Watt said she felt "a fraud" because the stereotypical hot flushes weren't as big a problem for her.

"It took me a while to work out that I was menopausal simply because of all the other factors," she said, listing the "forgetfulness, tiredness and distraction".

"But it's something you just brazen through," she added, explaining she was able to work her way through it, one day at a time.

The choir has worked with menopause support provider, Over The Bloody Moon (OTBM) and Cardiff firm Thread Design to create a "meno-vest" to mimic the effects of a hot flush so that others can better appreciate the impact.

"It's very accurate," said Sandy after trying it on. "It was a nasty reminder really."

Kath Turner from Talwrn on Anglesey runs menopause yoga classes, where women can discuss symptoms and tailor sessions to focus on specific issues.

"It provides an opportunity where women can talk to each other - they don't feel so alone and go away with some tools to help themselves.

"Women are beginning to become much more educated and informed around the menopause now, which is great because until fairly recently, women have had to struggle alone, not knowing what is happening to them.

"There's not always been a great deal of help available to them either."

The Welsh government said it took women's health very seriously and expected the NHS to provide a full range of services and support for women experiencing the menopause.

"The menopause is covered in GP training and in continuous professional development provided by Health Education and Improvement Wales," said a spokesperson.

"Our newly-established menopause expert group, which includes representatives from primary care, secondary care , as well as patient representation, will share best practice and establish a new menopause care pathway across Wales.

"We will publish a women's health plan in the autumn to help improve services.

"The minister for health is also part of the UK Menopause Task Force, which is looking at ways to better support women experiencing menopause."