Think menopause

Around 75% of women will experience menopausal symptoms; for 25% of women they are severe and can have a big impact on daily life (including on relationships and at work).

As well as periods eventually stopping altogether, some women experience low mood, anxiety, mood swings and low self-esteem, plus problems with memory or concentration (‘brain fog’). The most common physical symptoms are hot flushes and night sweats, and the less well known include urinary tract infections, dry and itchy skin and changes in body shape.

Many perimenopausal and postmenopausal women will experience a poorer quality of life too because of changing hormone levels. Without the right information, it can be difficult for women and healthcare providers to connect symptoms to the menopause.

Much of the problem could be solved if any woman over the age of 40 with a possible symptom and any professional who consults with them could ‘Think Menopause’ – and share their thinking with one another.

This shared approach can be supported further with consistent, trusted information. See Resources for a downloadable factsheet.

What is the goal?

The British Menopause Society is collaborating with NHS England (and eventually the NHS UK-wide) in order to raise the profile of potential menopausal symptoms – both for women and for healthcare professionals who may be less confident in this area of women’s health. Despite the recent publicity and the increased awareness around menopause, there is still a lack of knowledge and understanding among women.

Provision of the right information years before symptoms start will help women make personalised choices with the support of their primary care team.

We believe that a concerted effort on a ‘Think Menopause’ programme can, and will, have a significant impact. So, whenever a woman over 40 consults a healthcare professional, they both need to ‘Think Menopause’ and, if confirmed, ask whether hormone replacement therapy (HRT) could help?

The goal is that the shared ‘Think Menopause’ approach makes a major contribution to 100% of women experiencing good menopause care.

Menopause at a glance

• Menopause is traditionally defined as having occurred when a woman has not had a period for 12 continuous months.
• It usually occurs between 45 and 55. Early menopause is between 40 and 45, but for some women it may occur before 40 (premature menopause).
• Menopausal symptoms can be triggered by treatments for cancer, surgical removal of the ovaries and by some types of hormone therapy. 
• Symptoms can start years before periods stop as a result of varying hormone levels leading up to the menopause – the ‘perimenopause’ or ‘menopause transition’.
• Symptoms may continue long after the menopause (‘postmenopause’).
• Contraception is recommended for a further two years after the menopause if under 50, or for one year if over 50. If the diagnosis is unclear, contraception should be continued until 55.

So, at the least…

• 100% of women should be provided with a factsheet to inform them about menopause and potential treatment options when they attend for a health check around age 45
• Every woman is helped to make an informed choice on treatment options, including HRT.

Managing menopause

For many women, menopausal symptoms are mild and can be managed without specific treatment. For those with troublesome symptoms, the most effective treatment is HRT, although it may not be suitable for all women.

There are non-hormonal treatments too, and all clinicians, including community practitioners (CPs), are in an ideal position to support women to consider the pros and cons of the treatment options.

Applying ‘Think Menopause’ when women present in later life, for example with genitourinary symptoms, can help ensure appropriate treatment with vaginal oestrogen, which can be given lifelong.

Establishing at what age periods stopped can identify women who may have had an untreated premature or early menopause, leading to increased risk of osteoporosis and fracture.

All women seeking help and advice should have the opportunity to consult with a practitioner with a special interest in women’s health. Training and support for primary care including CPs will be required with a focus on the care pathway below for all stakeholders.

Despite the investment required, the net benefits to women’s health and society as a whole, including financial, will be significant.

A better future?

Women need to know that it’s okay to ask for help, even if symptoms are ‘not too bad’. Menopause is a big deal and they don’t have to get on with it on their own.

CPs can help by supporting women with management of symptoms, including provision of more information about different treatment options including contraception.

Postmenopausal bleeding (bleeding a year after a woman has her last menstrual period) should be investigated to rule out endometrial cancer which is increasing in prevalence in association with a global rise in obesity.

The innovation is for any woman over the age of 40 presenting, and the professionals they consult, to ‘Think Menopause’– whether it be for screening, a repeat prescription, or if they have physical or psychological symptoms. If we could raise awareness by this simple message we could improve women’s health and go a long way to, retaining our peri- and postmenopausal workforce, which would be hugely beneficial for the NHS and the wider economy.

Resources

• The menopause – a fact sheet produced by the NHS Menopause Clinical Reference Group and The Self Care Forum bit.ly/SCF_menopause
• British Menopause Society thebms.org.uk
• Women’s Health Concern is the patient arm of the BMS womens-health-concern.org
• Menopause Matters, founded by trustee and past chair of the BMS menopausematters.co.uk

Time to Reflect

How can you help clients – and indeed yourselves – to consider the menopause in health checks to ensure better menopause care?

Join the conversation on Twitter using #ThinkMenopause via @CommPrac

Paula Briggs is chair of the BMS, and a consultant in sexual and reproductive health based at Liverpool Women’s NHS Foundation Trust.