Interview conducted by April Cashin-Garbutt, MA (Cantab)
What did a recent survey prove to concerning the number of UK women that consult a healthcare professional concerning their menopause symptoms?
The survey showed that only 50% of women consulted a healthcare professional concerning their symptoms, despite the reality that lots of women said their symptoms were having a considerable effect on their job life, social life, house life and sex life.
In our survey, concerning 35% of women said the menopause significantly affected their work. It affected their functioning, their performance and their confidence.
If women aren’t having considerable symptoms that are too troublesome, then it’s okay if they don’t have to seek help. However, it’s not merely the reality that 50% weren’t seeking help, it’s concerning the number of women that were having symptoms that were affecting them, however seemingly not doing anything concerning it.
Did the survey go in to the reasons why these women weren’t seeking help?
It did. Some of the women didn’t believe the symptoms were bad enough and some of them felt they merely had to put up along with it and merely accepted it as a normal stage of life.
Some women felt that if they did go to see the GP, all that would certainly happen would certainly be that they would certainly be offered hormone replacement therapy (HRT) and a lot of women expressed a concern concerning the use of HRT.
Were you surprised by these results?
Given the NICE guidelines for menopause were published in November and generated a lot of media coverage in the UK, we’d hoped to see a lot more women stating they were seeking tips and recognising the support and post out there for them, however the survey highlighted the scale of the educational challenge that remains to guarantee women aren’t suffering in silence.
Can you please Provide an overview of the recently published NICE guideline on the diagnosis and management of the menopause?
It has actually various sections. The initial is concerning the importance of women getting information. There is awareness that women and healthcare professionals have actually been Offered rather mixed messages over the years, whether it’s from research studies or media reporting. There’s been a lot of confusion concerning the effects of the menopause and exactly how long effects Can easily last for, as well as concerning the benefits and risks of various treatments.
Women need to have actually access to accurate information, which is why we’ve made websites and updated resources, including online resources. We’ve given a lot of tools to tips women get hold of the right information.
The next thing is emphasizing the importance of individualization, since no two women are the same. exactly how the menopause affects women and Just what the rules are for different dietary and lifestyle changes or treatments, is rather individual. Also, even within one woman, it’s necessary to know that the stages of menopause and exactly how menopause is affecting her Can easily adjustment over the years, which then Likewise has actually an effect on her treatment needs.
Regarding diagnosis of menopause, the simple message is that for women aged over 45 that have actually menopausal symptoms such as a adjustment in periods or absent periods, we don’t have to do a blood test. In the past, blood examinations had frequently been taken to measure hormone levels and we feel that for lots of women, that’s not necessary. As well as the cost of the blood test, there’s Likewise the reason for yet another consultation to discuss the results, which means there is frequently a delay in starting management because they’re waiting for the results. The practical thing is to do much less blood examinations to diagnose menopause.
There is tips concerning women being aware of the guidance on diet and lifestyle changes, both to reduce their early symptoms and Likewise to improve their long-term health. post is required to tips women understand the different stages of going through the perimenopause and the menopause, the range of symptoms which could occur and Just what treatment choices are available.
For treatment of symptoms such as hot flushes, night sweats, and reasonable mood the recommendation is to offer HRT. For the majority of women, the benefits of HRT outweigh the risks.
There are Likewise some specifics concerning the benefits and risks of long term treatment, however for the early symptoms, the clear message is to offer HRT. At the moment, there are a lot of women experiencing symptoms that are having a big impact on their lives and that could benefit from treatment, however they accessing treatment as a result of perceived risks of HRT.
One of the resources we’ve made is an infogram concerning perceived risks and Likewise the big thing that women worry about, which is the risk of breast cancer. We’ve compiled a actually useful chart, which shows the numbers of women and the estimated expectation of association of breast cancer along with HRT, as well as its association along with drinking alcohol, and particularly obesity, which is a far bigger risk factor compared to the use of HRT. The message Concerning breast cancer is that HRT doesn’t cause cancer, however could promote the growth of cancer cells that are already present in some women.
Regarding the duration of treatment yet another message is that there’s no arbitrary limit. Often, in the past, if women have actually taken HRT, they’ve been told they would certainly have actually to stop it at a certain time. Actually, it’s up to the woman. If she’s taking it for symptoms, you Can easily never predict exactly how long the symptoms will certainly go on for, so you can’t predict exactly how long treatment will certainly be required for.
The British Menopause Society website is for health professionals, however we’ve added in the top ten messages in order to summarise the NICE guideline and tips people access the information.
Do you believe these guidelines will certainly encourage a lot more women to seek help?
The initial thing is for a lot more women to get hold of information. However, there is a concern that primary care in the UK is under huge pressure, so we don’t want people to believe we’re encouraging lots a lot more women to go to their GP and that GPs will certainly be more inundated.
The point is that if women get hold of access to post using, for example, the various resources we have actually to tips them, then, if they do go to their healthcare professional, they Can easily have actually a even more valuable discussion. You can’t cover all of the post that’s called for in a short appointment, so, inevitably, that may lead to yet another appointment. However, if women Can easily already be informed as soon as they go, then they Can easily have actually a a lot more informed discussion, which Can easily be actually useful.
Once women have actually got the information, it might be that some of them are actually able to make diet and lifestyle changes and that may be all that’s required. However, if they do require treatment, then they would certainly have to go to a healthcare professional to have actually that prescribed or they could wish to have actually a further discussion. Either way, it would certainly be valuable for them to have actually some post first.
In Just what means do you strategy to raise awareness of the NICE guideline?
The launch of the campaign in could was the initial portion of raising awareness and we wish to go on providing education. We give education for healthcare professionals through the British Menopause Society. We have actually a whole program of meetings planned and a publication that goes out to all our members.
For women, the campaign received a lot of media attention. That was great, however we Likewise have actually some points coming out in long lead publications, so we have actually various other menopause stories that will certainly be coming out over the next few weeks and few months or so. We chance that the use of our websites and the range of websites will certainly increase. We’re Likewise using social media, merely to preserve the message going. It’s a case of sort of drip feeding the message really, to preserve the awareness up; not merely awareness of the NICE guideline, however awareness of the importance of menopause.
What misconceptions do people have actually concerning the menopause?
First of all, I believe lots of women focus on the symptoms that they expect and that the majority of women do have, which are flushes and sweats. One misconception is that it’s merely concerning flushes and sweats and Just what we’re attempting to educate people concerning is that the menopause is all concerning a lack of estrogen. Women’s bodies become reasonable on estrogen because, in the majority of cases, our ovaries stop working. In a few women, the ovaries may be removed or may be affected by yet another treatment, however whatever type of menopause it is, it’s all related to the lack of estrogen.
What our survey reinforced is that there are frequently symptoms that women are not expecting such as reasonable mood, disturbed sleep and joint aches, although these are Likewise actually common. We are attempting to get hold of people to understand the various other effects of estrogen deficiency. Also, because we’re living longer, we’re going to live longer along with the consequences of estrogen deficiency.
When people are focusing merely on flushes and sweats, they don’t understand the later effects. Women will certainly frequently experience vaginal dryness and discomfort and bladder issues such as urinary infections and going to the loo a lot more frequently or a lot more urgently and all these points Can easily be related to lack of estrogen. The lack of estrogen Likewise affects our bone and heart health. Therefore, the misconception that it’s merely concerning flushes and sweats, means we’re missing all this various other necessary information.
I believe the various other misconception is that the early symptoms only last a short time, so we’ve seen a lot of women that merely put up along with it thinking, “Oh, this is going to go. It’s not going to last that long.” However, we now know that for lots of women, these symptoms that start early Can easily last a long time. Those early symptoms do resolve in a lot of cases, however we do know women in their 70s and 80s that still have actually them.
Also, among women whose symptoms do resolve, they then think, “That’s it, I’m through the menopause now.” If you merely focus on the periods stopping, flushes and sweats, you then don’t have actually that understanding that the physique is changing, as well as our bone and heart health and that we therefore do have to stop smoking, increase physical exercise and shed weight, if applicable, in order to Likewise improve long-term health.
There isn’t actually such a thing as, “I’m through the menopause now.” It actually is concerning thinking, “Okay, I’ve stopped having flushes, however my body’s still reasonable on estrogen. Just what else Can easily I do to tips that?”
Regarding treatments, the big misconception is that HRT is risky and dangerous, as soon as in fact, for the majority of women, there are a lot more benefits compared to risks.
What are the benefits and risks of HRT?
The big benefit is that it is still the most effective treatment for controlling symptoms that arise as a result of estrogen deficiency. We know it is helpful for bone health, and that if HRT is taken, it Can easily reduce the risk of osteoporosis and osteoporotic fractures. Even though it didn’t come from the NICE guideline, yet another point is that there is a lot more evidence suggesting that there might be a benefit on heart health if HRT is started early in the menopausal stage.
We used to believe that 15 years ago and women frequently took HRT for that benefit, even if they didn’t have actually the symptoms. However, a publication that changed that view on HRT was an American trial that was published in 2002. Since then, it has actually been reanalyzed lots of times and people have actually returned to thinking that HRT in the early years is probably protective versus heart disease. It had been seen as a risk, but, in fact, it is probably a lot more most likely to be a benefit.
There is an established, rather small increased risk of having a deep vein thrombosis or a blood clot as soon as taking the tablet form of HRT, so for women along with risk factors for those, such as being overweight, we would certainly recommend using estrogen that is absorbed through the skin, which is either in the form of a patch or a gel. Administration by that route doesn’t have actually the same effect on our clotting system.
Then, the big concern is the breast cancer risk. The current understanding is that HRT doesn’t cause breast cells to turn in to cancer, however that certain types of HRT could promote the growth of cancer cells that are already there if it is taken for a lot more compared to 5 years after the age of 50.
The necessary point here is that we have actually to individualize. All women will certainly have actually an personal baseline risk of breast cancer; two women will certainly have actually rather different risks of producing breast cancer. It is a myth that HRT triggers the cancer. It could promote the growth of cancer cells already present by a small count in some women. However, it’s certain types of HRT and, versus that, are the benefits we’ve described.
What a lot more should be done to educate women concerning the post and support available?
We wish to get hold of the word out there as much as possible. There was a lot of press interest in May, which was terrific and some a lot more since then, so it’s carrying on. There are radio programme opportunities and I was on one of our television programs recently, which was great.
We have actually various avenues for using social media. We’re merely attempting many different means to get hold of the message out to women. There are the websites I’ve mentioned and I Likewise publish a magazine called Menopause Matters.
We’re happy to job along with patient organizations. Since last week, we’ve already heard of a couple of people that are wanting to run group sessions for women, which we’re Likewise happy to tips with. We tips in any means we Can easily really.
What do you believe the future holds for managing menopause symptoms?
I believe HRT has actually a lot of benefits. Not every woman would certainly be advised to take HRT. For lots of women, simple points like diet and lifestyle changes Can easily actually make a big difference, however for those that want personal treatments, I believe we still have actually a lot of myths concerning risk to dispel and that we have to Provide women accurate post so they Can easily make informed choices. At the moment, a lot of women are still making decisions based on old post or these myths that I have actually mentioned.
Since we know the consequences related to estrogen deficiency, it makes sense to have actually a rather valuable treatment that is going to put the estrogen spine and replace Just what our bodies have actually stopped producing. We know there are many benefits. We know that it’s not perfect; I don’t believe any medication is perfect, however now there is research looking at exactly how we Can easily maximize the benefits and absolutely minimize the risks.
The risks are already rather small, however there is a lot more interest in different means of replacing the estrogen in as safe a means as possible. We reason a lot more scientific research on this, however we do have actually brand-new preparations that will certainly hopefully start to appear.
Diet and lifestyle are hugely important. There are some alternatives that might be helpful, so perhaps we reason a lot more research on those. There has actually been a concern concerning standardization of products and the products that we buy over the counter not being regulated in the same means as prescribed medicines. We could do along with a lot more post concerning those preparations, so that we are able to trust what’s in them. We still reason a lot more research.
What’s your vision for the British Menopause Society?
The British Menopause Society’s aim is to support and educate healthcare professionals. In the UK, the majority of care is Offered in primary care, so within primary care, we would certainly love there to be a general basic understanding of the menopause and treatment options, which the NICE guideline has actually Offered us.
We merely have to go on to give simple versions of that. The full document is huge and busy GPs and method nurses are unlikely to read it, so we have actually given a summary and key messages. It’s all concerning women getting consistent information. exactly how they are advised shouldn’t depend on where they live or that they go to see. Even though we do have actually to individualize, there are some basic messages that we wish to be consistent.
One aim of the British Menopause Society is to support education at the primary care level, however we would certainly love there to be a menopause specialist service within each region. Some women could have actually complex medical histories that could mean edge effects from treatments, in which case there should be a person that the primary care Can easily refer to. Whether it’s actually referring the patient, whether it’s email advice, a phone call or whatever it is, support should be given at a specialist level.
What we wish to do is job throughout the country, looking at exactly how we Can easily support people to get hold of the appropriate education. We have actually training courses to get hold of to that specialist level, so that there Can easily be specialist services within each region. To do that, we Likewise have to job along with commissioning groups. This is portion of the whole pointer concerning raising awareness of menopause, to try and encourage funding to give these services.
Where Can easily readers locate a lot more information?
There is the British Menopause Society website, which is aimed at healthcare professionals, however it Likewise links to Women’s Health Concern, which is the patient charity arm of the British Menopause Society.
In addition, there is Menopause Matters and we publish a magazine as well. There’s very a brand-new website called managemymenopause.co.uk, which gives women a lot more tailored information. This allows people to put in their history, their circumstances and then print off a lot more of an individualized tips sheet.
For women that have actually premature menopause, there’s a support group called the Daisy Network, which is specifically for younger women. They all link with each other and complement each other. They all give something a bit different and we don’t mind which ones women use. They may wish to check out them all and they’re all actually valuable resources.
About Dr Heather Currie
