Personal view
Reinventing the general practitioner menopause clinic – personal experiences
Post Reproductive Health 2014, Vol. 20(3) 117–118 ! The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/2053369114536151 prh.sagepub.com
Anu Mehra
Abstract Menopause is accompanied by a plethora of symptoms. The 10 minute general practitioner consultation is ineffective in addressing all these symptoms. My experience of offering a 1 hour assessment and management has very positive and encouraging results. Should this be made available in general practice and will it prove more cost effective in the long run and also lead to greater patient satisfaction?
Keywords Estrogen, general practice assessment, hormone replacement therapy, menopause, osteoporosis, urogenital atrophy, vasomotor symptoms
Introduction Women’s health is global health priority and management of post-reproductive health is becoming a key issue for all health professionals.1 The British Menopause Society and Women’s Health Concern have key recommendations that all women should have access to advice on how they can optimise their menopause transition and beyond with emphasis on lifestyle, diet and an opportunity to discuss pros and cons of hormone replacement therapy (HRT) and complimentary therapy.2 The word menopause is derived from the Greek word ‘menos’ meaning month and ‘pausos’ meaning an ending. It is the time of life during which the woman finally ceases to menstruate, aged 45–55 with an average age in the UK of 51 years. This time of life brings about many changes in a woman’s life including relationship changes with family, friends, associates, etc. Physically there are changes, hormones fluctuate and many psychological factors come into play. The plethora of symptoms related to the menopause includes: . Vasomotor * Hot flushes, night sweats . Psychological * Depression, anxiety, irritability, fatigue, forgetfulness, low self-esteem and lack of concentration . Urogenital * Vaginal dryness, infections, urinary urgency/frequency, dysuria, incontinence both stress and
. . . .
urge, dyspareunia, loss of libido, increased sensation of vaginal/uterine prolapse Disturbances in menstruation * Shorter, longer, heavier or lighter cycles Risk of osteoporosis Cardiovascular disease Hair, skin and nail problems.
Treatment of menopausal symptoms is complex due to a lack of understanding of their aetiology. The publicity around HRT and possible adverse effects has left clinicians and women very confused which may well have left many women reluctant to talk about their symptoms. Alternative and complementary therapy choices are widely available but proof of efficacy and safety is hard to come by, making an informed choice difficult. There is little doubt that effective management of the menopause could improve the quality of life of millions of women. Hopefully, the development of National Institute for Health and Clinical Excellence clinical guidelines on the diagnosis and management of menopause currently in preparation will help educate and inform doctors and patients alike. Great Lever Health Centre, Bolton, UK; Lever Chambers Centre for Health, Bolton, UK Corresponding author: Anu Mehra, Great Lever Health Centre, Rupert Street, Greater Manchester, Bolton BL6 6RN, UK. Email: [email protected]
Downloaded from min.sagepub.com at Karolinska Institutets Universitetsbibliotek on May 31, 2015
118
Post Reproductive Health 20(3)
My initiative: The general practitioner menopause clinic Keeping the above factors in mind I was convinced there is currently a big role that general practitioners (GPs) can play in the assessment and management of these women. I set up a service to address this problem and made available sessions lasting up to an hour of my time per patient to take a detailed history and make a biopsychosocial assessment of the woman presenting with symptoms that might be attributable to the menopause. The service was advertised in the surgery and selfreferrals accepted and referrals were also made by the nurse and other GPs. On initial audit, the service was rated very highly and met with nearly 100% patient satisfaction. Further analysis of the service revealed that many women had consulted their GP about several issues over a long period of time, taking up numerous 10 minute consultations. It was also seen that following the 1 hour detailed assessment and advice of the treatment options the consulting behaviour of these women had changed in that they were not presenting to the GP again and the number of appointments was reduced. The reduction in attendances after the 1 hour menopause clinic appointment was up to 50% with certain patients. Factors such as other GP consulting styles and reasons for appointments were not looked at in detail, warranting further study. I found that offering an hour of my time tackled and developed an understanding of the presenting symptoms during the menopause. Longer consultations are associated with better outcomes and increasing patient participation means more complex interaction but hopefully with better outcomes.3,4 Consultation length has been determined by doctor and patient variables and it has been found that women consulting in an urban practice with problems perceived as psychosocial have longer consultations than other patients.5 Both the British Medical Association and Royal College of General Practitioners have called
for increasing GP consultation times to improve care and deal with complex issues of the increasing elderly population and others.
Comment We should accept that these women need additional help and we as GPs should be able to offer a longer consultation for their assessment and management. Is it practical? I feel if an hour of my time leads to a reduction in future appointments it evens out in the end and leads to more patient satisfaction. Not only is a longer appointment and detailed assessment of value in itself, it also allows the full analysis of each woman’s menopause symptom complex. Such an individualised service is necessary if we are to help millions of women every year. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Conflict of interest None declared.
References 1. Rees M, Stevenson J, Hope S, et al. Management of the menopause, 5th ed. 1st published by The Royal Society of Medicine Press Ltd., Edward Arnold Ltd: London, 2011. 2. Panay N, Hamoda H, Arya R, et al. The 2013 British Menopause Society and Women’s Health Concern recommendations on HRT. Postreprod Health 2013; 19: 59–68. 3. Freeman GK, Horder J, Howie JGR, et al. Evolving GP consultations in Britain: issues of length and context. BMJ 2002; 324: 880–882. 4. Morrell DC, Evans M, Morris RW, et al. The five minute consultation: effect of time constraint on clinical content and patient satisfaction. BMJ 1986; 292: 870–873. 5. Deveugele M, Derese A, Van den Brink-Muinen A, et al. Consultation length in general practice: cross-cultural study of 6 European countries. BMJ 2002; 325: 472.
How To Cite Mehra A. Reinventing the general practitioner menopause clinic – personal experiences. Post Reproductive Health 2014; 20(3): 117–118.
Downloaded from min.sagepub.com at Karolinska Institutets Universitetsbibliotek on May 31, 2015
Reinventing the general practitioner menopause clinic – personal experiences
Post Reproductive Health 2014, Vol. 20(3) 117–118 ! The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/2053369114536151 prh.sagepub.com
Anu Mehra
Abstract Menopause is accompanied by a plethora of symptoms. The 10 minute general practitioner consultation is ineffective in addressing all these symptoms. My experience of offering a 1 hour assessment and management has very positive and encouraging results. Should this be made available in general practice and will it prove more cost effective in the long run and also lead to greater patient satisfaction?
Keywords Estrogen, general practice assessment, hormone replacement therapy, menopause, osteoporosis, urogenital atrophy, vasomotor symptoms
Introduction Women’s health is global health priority and management of post-reproductive health is becoming a key issue for all health professionals.1 The British Menopause Society and Women’s Health Concern have key recommendations that all women should have access to advice on how they can optimise their menopause transition and beyond with emphasis on lifestyle, diet and an opportunity to discuss pros and cons of hormone replacement therapy (HRT) and complimentary therapy.2 The word menopause is derived from the Greek word ‘menos’ meaning month and ‘pausos’ meaning an ending. It is the time of life during which the woman finally ceases to menstruate, aged 45–55 with an average age in the UK of 51 years. This time of life brings about many changes in a woman’s life including relationship changes with family, friends, associates, etc. Physically there are changes, hormones fluctuate and many psychological factors come into play. The plethora of symptoms related to the menopause includes: . Vasomotor * Hot flushes, night sweats . Psychological * Depression, anxiety, irritability, fatigue, forgetfulness, low self-esteem and lack of concentration . Urogenital * Vaginal dryness, infections, urinary urgency/frequency, dysuria, incontinence both stress and
. . . .
urge, dyspareunia, loss of libido, increased sensation of vaginal/uterine prolapse Disturbances in menstruation * Shorter, longer, heavier or lighter cycles Risk of osteoporosis Cardiovascular disease Hair, skin and nail problems.
Treatment of menopausal symptoms is complex due to a lack of understanding of their aetiology. The publicity around HRT and possible adverse effects has left clinicians and women very confused which may well have left many women reluctant to talk about their symptoms. Alternative and complementary therapy choices are widely available but proof of efficacy and safety is hard to come by, making an informed choice difficult. There is little doubt that effective management of the menopause could improve the quality of life of millions of women. Hopefully, the development of National Institute for Health and Clinical Excellence clinical guidelines on the diagnosis and management of menopause currently in preparation will help educate and inform doctors and patients alike. Great Lever Health Centre, Bolton, UK; Lever Chambers Centre for Health, Bolton, UK Corresponding author: Anu Mehra, Great Lever Health Centre, Rupert Street, Greater Manchester, Bolton BL6 6RN, UK. Email: [email protected]
Downloaded from min.sagepub.com at Karolinska Institutets Universitetsbibliotek on May 31, 2015
118
Post Reproductive Health 20(3)
My initiative: The general practitioner menopause clinic Keeping the above factors in mind I was convinced there is currently a big role that general practitioners (GPs) can play in the assessment and management of these women. I set up a service to address this problem and made available sessions lasting up to an hour of my time per patient to take a detailed history and make a biopsychosocial assessment of the woman presenting with symptoms that might be attributable to the menopause. The service was advertised in the surgery and selfreferrals accepted and referrals were also made by the nurse and other GPs. On initial audit, the service was rated very highly and met with nearly 100% patient satisfaction. Further analysis of the service revealed that many women had consulted their GP about several issues over a long period of time, taking up numerous 10 minute consultations. It was also seen that following the 1 hour detailed assessment and advice of the treatment options the consulting behaviour of these women had changed in that they were not presenting to the GP again and the number of appointments was reduced. The reduction in attendances after the 1 hour menopause clinic appointment was up to 50% with certain patients. Factors such as other GP consulting styles and reasons for appointments were not looked at in detail, warranting further study. I found that offering an hour of my time tackled and developed an understanding of the presenting symptoms during the menopause. Longer consultations are associated with better outcomes and increasing patient participation means more complex interaction but hopefully with better outcomes.3,4 Consultation length has been determined by doctor and patient variables and it has been found that women consulting in an urban practice with problems perceived as psychosocial have longer consultations than other patients.5 Both the British Medical Association and Royal College of General Practitioners have called
for increasing GP consultation times to improve care and deal with complex issues of the increasing elderly population and others.
Comment We should accept that these women need additional help and we as GPs should be able to offer a longer consultation for their assessment and management. Is it practical? I feel if an hour of my time leads to a reduction in future appointments it evens out in the end and leads to more patient satisfaction. Not only is a longer appointment and detailed assessment of value in itself, it also allows the full analysis of each woman’s menopause symptom complex. Such an individualised service is necessary if we are to help millions of women every year. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Conflict of interest None declared.
References 1. Rees M, Stevenson J, Hope S, et al. Management of the menopause, 5th ed. 1st published by The Royal Society of Medicine Press Ltd., Edward Arnold Ltd: London, 2011. 2. Panay N, Hamoda H, Arya R, et al. The 2013 British Menopause Society and Women’s Health Concern recommendations on HRT. Postreprod Health 2013; 19: 59–68. 3. Freeman GK, Horder J, Howie JGR, et al. Evolving GP consultations in Britain: issues of length and context. BMJ 2002; 324: 880–882. 4. Morrell DC, Evans M, Morris RW, et al. The five minute consultation: effect of time constraint on clinical content and patient satisfaction. BMJ 1986; 292: 870–873. 5. Deveugele M, Derese A, Van den Brink-Muinen A, et al. Consultation length in general practice: cross-cultural study of 6 European countries. BMJ 2002; 325: 472.
How To Cite Mehra A. Reinventing the general practitioner menopause clinic – personal experiences. Post Reproductive Health 2014; 20(3): 117–118.
Downloaded from min.sagepub.com at Karolinska Institutets Universitetsbibliotek on May 31, 2015
