How Do You Get The Right Support For Your Menopause From Your GP?

Every day I have women within the Menopause Club struggling to get the right help from their GP. This isn’t an article bashing GPs, they do an amazing job but they are often ill-informed on the most up-to-date information on menopause. Now this isn’t the case for all GPs and some are incredibly knowledgeable but this is because they’ve take an specific interest in educating themselves.

As an example: I had a woman aged 49 saying her GP told her “Your blood results aren’t bad enough for HRT”. Now there are several things wrong with this statement.

• The NICE guidelines on the menopause created for GPs state blood tests shouldn’t be used to diagnose menopause if a woman is over 45 and presenting with symptoms.
• Blood test results should not be used to decide if HRT is the right course of treatment for a woman.

This is a care algorithm produced by Guidelines which summarises clinical guidelines for primary care. Now this might look complicated but the biggest takeaway from this is that my client should have been offered HRT (after considering risk factors), if it was the treatment option she felt most appropriate for managing her symptoms.

So many women are finding the menopause a struggle and they should be receiving better support. In examples where  a GP provides amazing support for their patient, it makes such a huge difference on their life and the patient outcomes.

I’m currently working with our local GPs and the Health Innovation Campus in Lancashire and I hope as menopause becomes more of a focus things will change. In the meantime we need to take some ownership. So what do you need to know and what should your doctor know?

What Should You Know Before Seeing Your GP?

• Be clear on your personal symptoms and how things have changed for you. You know your body the best and you know “your” normal.
• Use a symptoms tracker so you can provide specific information – this can be as simple as a notebook or you can download our free tracker “What’s My Body Trying to Tell Me?” Which now includes a GP summary sheet to help with your next GP visit.
• Do your research – take a look at the NICE guidelines – https://www.nice.org.uk/guidance/ng23
• If you feel you may struggle to get your point across or take on information, take a friend or family member with you, it can be great to have support
• List any questions you have about treatment, symptoms – it can be easy to forget things once you’re with the doctor
• Give your doctor time to find out if they don’t know – GPs aren’t given a lot of training on menopause as standard so this may not be their area of expertise.
• You can ask for a longer appointment – many GPs actually appreciate this as they can take time to understand your symptoms. Deciding on the right course of action for your menopause is very difficult in a 10 minute appointment

What Should Your Doctor know?

• The average age for reaching menopause is 51 but for many women peri-menopause symptoms often start in their 40s
• Your doctor should have read and applied the NICE guidelines on Menopause.
• Surgical menopause affects women who have been through a hysterectomy and it is recommended these women receive HRT (when appropriate) to protect their long-term health
• Premature menopause affects one in a hundred women under the age of forty, one in a thousand women under thirty and one in ten thousand under twenty. It is very important that women in premature menopause are counselled about the importance of hormone replacement therapy (where appropriate) to protect their long term health.
• Symptoms are not just hot flushes and changing periods. As we know many women experience mental and emotional symptoms before physical symptoms start
• Additional physical symptoms on top of hot flushes and period changes include palpitations, feeling tired or lacking energy, feeling dizzy or faint, headaches, joint pain, itchy skin, hair loss, vaginal dryness, increased urinary tract infections and loss of libido.
• HRT is the first line of treatment for menopause symptoms. The NICE guidelines state “Do not routinely offer selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs) or clonidine as first-line treatment for vasomotor symptoms alone.” Too many women are diagnosed with depression and treated with anti-depressants when menopause should be considered
• Women who still have their womb must be prescribed oestrogen and progesterone to protect the womb lining.

Questions to consider when speaking to your GP?

I am not suggesting you sit down with your GP and go through all of these questions. These are taken from the NICE guidelines for patients and making a note of a couple of questions most relevant to you should help you have a constructive conversation on your treatment.

• What types of treatment are suitable for my symptoms?
• What are the benefits and risks of different treatments?
• Are there any complementary therapies that could help?
• I use complementary therapies for my symptoms – are these safe to take alongside other treatments?
• If I already take an antidepressant, will that affect any treatments I can try for mood changes during menopause?
• Can you tell me why you are recommending hormone replacement therapy (HRT)?
• If I don’t want to take HRT, or can’t for medical reasons, what other treatments are there?
• What type of HRT is suitable for me?
• How quickly will HRT improve my symptoms?
• Can I still become pregnant on HRT?
• How and when do we decide I should stop taking HRT?
• Might I have problems when I stop taking HRT?
• Are there any serious side effects from HRT?
• Are there any long-term effects of taking HRT?

The most important thing is that you get the right support and you don’t suffer in silence.