The results of the survey that we undertook regarding menopause training and education were recently published, and the findings were enlightening and also concerning.

I speak to hundreds of women who tell me that they are unable to access any decent menopause care or support. Many of these women have tried by visiting numerous healthcare professionals. I receive many messages from women via social media telling me heart-breaking stories about being told by their doctors that HRT is too “dangerous”, it will “cause breast cancer” or it is “a lifestyle drug and is no longer prescribed”. Around 70% of women I see in my menopause clinic have either been given or offered, inappropriately, antidepressants for their menopausal symptoms, despite these not being recommended first line for menopausal women.

Although I realise there are a huge number of GPs and other healthcare professionals who adequately support and manage women during their perimenopause and menopause, there are still many who have had inadequate menopause training and are still unaware of the NICE guidance on diagnosis and management of the menopause, which were published in November 2015.

           

Menopause care needs to be mainly delivered in primary care, involving GPs, nurses and also pharmacists

Our survey showed that only half the healthcare professionals who responded had previously received any training in the menopause.

Although the vast majority thought the menopause should be managed at primary care level, only 66% felt confident in managing the menopause. The guidelines are very clear that women who have an early menopause should receive hormone replacement therapy (HRT), until at least the average of the menopause (51 years).1,2,3 However, only around a half of healthcare professionals answering this survey felt confident in treating young women with early menopause.

The survey included questions regarding knowledge about HRT and the menopause. One of the main reasons that women are worried about taking HRT is the perceived increased risk of breast cancer. The facts regarding risk of breast cancer with HRT are clear from the evidence; young women taking any type of HRT and those women taking oestrogen-only HRT do not have an increased risk of breast cancer. However, around a quarter of people answering the survey incorrectly thought that any type of HRT increases the future risk of breast cancer and the vast majority, 74%, thought that taking oestrogen only HRT increases the risk of breast cancer.

It is therefore likely that these misconceptions regarding risks of HRT are then transferred to women, which is fuelling the anxiety and concerns about HRT among so many women. Body identical HRT is far safer than so many women and healthcare professionals realise.5,6

The results of this study are going to be presented as a poster at the 16th World Congress on the Menopause in Vancouver in June. The conference, which takes place every two years, offers an exciting, innovative and varied scientific programme. This year’s event is titled: “Midlife health in the 21st century,” and will include  a particular focus on the problems of the perimenopause and premature ovarian insufficiency.

With so many of the world’s leading menopause experts in one place, we’re delighted to be able to present the findings of the survey. I am sure many doctors across the world will acknowledge that results would have been similar if this study had been undertaken in their countries.

There is a desperate and urgent need for more evidence-based menopause care to occur in the UK and worldwide. Many healthcare professionals have had very little training and education about the perimenopause and menopause and this needs to change. Menopause care needs to be mainly delivered in primary care, involving GPs, nurses and also pharmacists. Women need to receive an individualised consultation at all stages of diagnosis, investigation, and management of their menopause.

The results indicate that wider and deeper education campaign to primary care providers is required. Many thanks to all of you who participated in this important work!

 

References

1. National Institute for Health and Care Excellence. NICE guideline NG23 – Menopause: diagnosis and management 2015 [May 2017]. Available from: https://www.nice.org.uk/guidance/ng23
2. Baber RJ, Panay N, Fenton A, Group IMSW. 2016. Climacteric 2016;19:109-50
3. Hamoda H, Panay N, Arya R, Savvas M. Post Reproductive Health 2016;22:165-83
4. Management of women with premature ovarian insufficiency. 2015 https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Management-of-premature-ovarian-insufficiency.aspx
5. Stute P, Wildt L, Neulen J. Climacteric. 2018 Apr;21(2):111-122.
6. L’Hermite. Climacteric 2017; 20:331-338.


Dr Louise Newson Women’s Health Consultant Editor