In my discussions with working women around the subject of menopause, I invariably hear stories of women in their 40s who have sought the advice of their GP with what they think may be menopause related symptoms, just to be told by the GP that they are too young to be menopausal.
Often the advice they are given goes something like:
You can’t be in menopause because you are still having periods.
You probably aren’t menopausal as your symptoms aren’t bad enough, come back if they get worse.
I can’t prescribe HRT because you have a history of breast cancer in the family.
I can’t prescribe HRT because you are at risk of blood clot.
You need to come off HRT because you’ve been on it for 5 years.
It sounds like you’re depressed I’ll prescribe you anti-depressants
None of the above advice is valid or necessarily true.
However, I have always found it awkward to challenge the advice given by the GP because I am not medically qualified and therefore may be seen to lack the credibility to dispute the advice given by someone who is.
I recall the first menopause awareness workshop I ever delivered. In the audience was one man, out of 30 women. At the end of the session he approached me and thanked me for a highly informative and interesting workshop. But what he said next rather shocked me.
He told me that he’d learned more about menopause during the 3 hour workshop by listening to the information I was sharing and hearing the personal stories of the women on the course, than he had in 28 years as a GP.
He went on to tell me that the majority of GPs don’t receive training in menopause, despite the fact that this natural phase in a woman’s life cycle will affect possibly half of his patients directly and all of his patients indirectly.
He felt strongly that menopause awareness training was important and that I should continue to get the message out to as many businesses as I could (which I’m happy to say is exactly what I’ve been doing for the past 2 years).
So I was interested to read an article in the latest publication of The British Menopause Society’s magazine ‘Post Reproductive Health’ written by Tony Mander and titled ‘Working Doctors and their Menopause’. In it, he confirms and reinforces what I’ve learned to be true, that where GPs are concerned there is a “lack of knowledge and information relating to the modern management of the menopause and perhaps most importantly, the risks and benefits of various forms of treatment”.
There are currently only 143 trained and accredited menopause specialists in the UK according to the BMS and there appears to be a lack of uptake by medical practitioners to upskill where menopause is concerned.
This inevitably means that many GPs are administering inaccurate advice, prescribing ineffective medication or refusing to prescribe medication that could be, quite frankly, life changing for some women.
The flawed findings of the 2002 Women’s Health Initiative study are still being used by some GPs as the basis for their advice to patients despite the fact that more current studies and re-analysis of existing data, suggests that HRT not only reduces the impact of symptoms but also confers very many long term health benefits.
The BMS article goes on to remind us that 1 in 6 women are likely to live beyond 100 years but this creates long term health issues for women who may be living up to half of their life deficient in key hormones oestrogen, progesterone and testosterone.
He says that “The benefit of fundamental importance with HRT is in preserving disability free life” – is there any point in living longer if we can’t live an independent, disability free life?
Encouragingly, the BMS recently launched a brand new training programme for healthcare practitioners entitled “Principles and Practice of Menopause Care (PPMC)”.
The BMS states that the programme has been designed for healthcare professionals, to encourage high quality menopause support for women.
In their press release issued on World Menopause Day, 18 Oct 2020, Haitham Hamoda, Clinical Lead for the Menopause Service at King’s College Hospital and Chair of the BMS said:
“The BMS Vision for menopause care in the UK sets out our strategy to improve medical support for mid-life and older women. It highlights what support and care is currently available; what we believe should be available for healthcare professionals (HCPs) and their patients, how the coronavirus pandemic is bringing challenges but leading to more innovative ways of working. The Vision highlights the need for more support for women in the workplace.
For the vast majority of women, expensive, private specialist menopause care should not be required and yet I often hear of women spending hundreds of pounds on private consultations in order to get general menopause advice that they feel they can rely on.
If GPs have a good understanding of the underlying hormonal changes that occur during perimenopause and the range of symptoms those changes can bring about, they should be able to reassure women that what they are going through is quite normal. They would have the knowledge needed to prescribe the best medication, rather than what is often the case currently. For example where the default often seems to be anti-depressants which in most cases do not treat the symptoms for which they’re being prescribed.
Let’s hope that more GPs and health professionals take up the training, so that women are no longer left feeling confused, dejected and dismissed by the very person they should feel able to trust to give them the best possible advice.