The reasons why women need a menopause doctor
Published: 4th March 2019
The menopause is a natural process that all women will go through, if they live long enough, but it comes with a range of potential side effects such as hot flushes, night sweats, anxiety, low mood, memory problems and migraines. In this article, Dr Louise Newson explains that a GP isn't always best placed to deliver the specific advice needed and details the reasons why women should see a specialist menopause doctor.
Original article below:
Reasons to see a menopause doctor
As a menopause specialist, I spend all my working time thinking about the menopause – talking in my clinic to patients, lecturing to GPs and nurses, writing articles about the menopause and also attending conferences to improve my knowledge and understanding about the menopause.
The menopause is a natural process which all women go through if they live long enough. It occurs because our ovaries stop producing eggs, so the levels of the hormones oestrogen and testosterone fall. Some women have an induced menopause due to an operation or medication.
The majority of women experience symptoms which include hot flushes and night sweats, anxiety, low mood, memory problems, migraines, reduce energy, urinary symptomsan reduced libido.
All menopausal women, whether they experience symptoms or not, have an increased risk of heart disease, osteoporosis, type 2 diabetes, obesity, osteoarthritis and dementia as hormones have really important affects in so many different organs in our bodies.
It is therefore essential that women receive correct advice and treatment for their menopause and perimenopause (the time when periods start changing and symptoms often start) so their future health can be optimised.
There are many GPs who offer excellent menopause care in their practices and numerous women receive superb treatment. However, there are GPs who have had little or no training in the menopause and many tell me that they are not confident in prescribing HRT to women.
Despite my menopause expertise, I personally received very little menopause training as an undergraduate or postgraduate. All my menopause learning has been self-directed as I have a passion in improving women’s health and helping women to have a positive experience of their menopause by giving them individualised, evidence-based and non-biased consultations.
NHS menopause clinics are sadly closing in various regions in the UK and there is little provision to work as a menopause doctor in the NHS. I have recently opened a menopause and wellbeing centre in Stratford-upon-Avon which has other liked-minded GPs working with me to provide individualised consultations to perimenopausal and menopausal women.
Advantages of seeing a menopause doctor:
1. You will be given time
It can be really difficult to give women adequate information in a 10 minute appointment as a GP. In dedicated clinics, both NHS and private, doctors usually have longer consultation times so we have the opportunity to explore women’s individual concerns and symptoms. This means adequate time can be given to discuss treatment options relevant for each woman. Many women feel that if potentially they are going to take HRT for many years they like to invest in the time with an expert who can give them all the information they need to make a clear informed choice.
2. You will see the same doctor
Many women tell me that they find it really hard to see the same doctor for follow up appointments and different doctors often give conflicting advice about symptoms and treatment. In menopause clinics, women usually see the same doctor or healthcare professional for their follow up appointments which means that there is a continuity of care. This both improves patient satisfaction and also is far more rewarding for the individual doctor.
3. Your treatment will be based on the NICE guidance on diagnosis and treatment of the menopause
In 2015, NICE published the first National Institute for Health and Care Excellence (NICE) guidelines on menopause, clearly stating that for the majority of women the benefits of taking HRT outweigh any risks. Frustratingly, many doctors I lecture tell me that they have never read these guidelines and this means many women are not receiving optimal menopause care. Doctors should be working from these guidelines and all menopause doctors refer to these guidelines to ensure their patients receive the best evidence based care.
4. You will not be told that hot sweats and flushes are symptoms you “just have to put up with”.
Vasomotor symptoms affect around 75% of women and they are not just embarrassing and inconvenient. They disrupt the blood supply to the brain momentarily and research has shown that those women who suffer these symptoms are more likely to develop heart disease, osteoporosis and diabetes in the future. Women should not be told to just try and put up with them!
5. You will be usually be offered body identical HRT which is the most effective and safest HRT available (NOT to be confused with compounded bio-identical HRT)
HRT is only three letters – Hormone Replacement Therapy. There are different types and doses of hormones, so it is important women receive the right type of HRT for them. The safest way of having oestrogen is through the skin as a patch or gel as there is no risk of clot. There is a small increased risk of clot in women who take oestrogen as a tablet. Women also need to take a progestogen to protect the lining of the womb (unless they have had a hysterectomy). The safest type to take is micronised progesterone which is an oral capsule. Studies have shown that there is no risk of breast cancer in women taking this type of HRT for five years and after this time the risk is so small it is not even significant. A woman’s individual risk of breast cancer is much higher if they drink a couple of glasses of wine most evenings or if she is overweight (as these are both risk factors for breast cancer).
Body identical HRT means that the hormones have the same molecular structure as our hormones. They are derived from yams, which are tropical root vegetables. Compounded bio-identical hormones are used in many private clinics and are not regulated nor subject to any quality control. There is no evidence to support their use and guidelines do not recommend that they should be used.
6. You will not be given antidepressants if you need HRT
Many women in my clinic tell me that they have been experiencing emotional and mood symptoms, often for many years. They often tell me that they have no motivation, little interest or enjoyment in life and they feel “flat” or “joyless”. They are irritable, anxious and unhappy. Studies show that up to half of women suffer menopause-related anxiety. Almost a third of women will suffer depression for the first time, and in women with a history of depression, that rises to a shocking 59%.
It is no coincidence that there is a peak in suicide rate in women in their early 50s – sadly on some occasions it has not occurred to the woman herself or to health care professionals she has already been in contact with that her psychological problems may have been related to her hormones.
A recent survey I undertook of nearly 3000 women showed that 66% of women had been given antidepressants rather than HRT by their doctors. The NICE guidelines are very clear that HRT should be given as first line treatment for women with low mood in the perimenopause who do not have clinical depression. Giving HRT stabilises oestrogen levels which then leads to improvement of mood.
7. You will be offered testosterone if appropriate
Testosterone is actually produced in larger quantities than oestrogen in women and levels reduce as we age and after the menopause. Low testosterone levels can lead to reduced libido and also have a negative effect on mood, energy and concentration. Low levels can also contribute to osteoporosis and reduced muscle strength. There are currently no licensed testosterone preparations for women in the UK. Many doctors prescribe lower doses of the men’s preparations (usually gels) or AndroFeme which is a cream made for women imported from Australia. Many GPs have not had training about testosterone use in women. Many women find that taking testosterone gives them more mental focus, stamina and improve their joie de vivre, as well as often improving libido.
8. You will be offered holistic advice about your perimenopause or menopause
The management of the menopause is not just about prescribing HRT; also many women choose not to take HRT or cannot take it for medical reasons. It is essential that we optimise our nutrition, exercise, sleep and wellbeing during this important time of our lives. We have an excellent nutritionist working closely with us, Emma Ellice-Flint, who is a qualified nutritionist, nutritional therapist and experienced chef. She has amazing skills at guiding women through their own nutritional journey to eat for vitality, hormone balance and weight balance by using evidence-based nutrition advice, professional education and research.
I personally practice asthanga yoga regularly which is really beneficial to my menopause. We have a yoga studio in my clinic and have different yoga teachers who are very experienced in teaching different styles of yoga according the woman’s ability and needs. Yoga is a fantastic exercise for the entire body. It can also improve some of the symptoms of the menopause, including sleep disturbance, fatigue, low mood and anxiety. Our muscle tone and bone density reduce during the perimenopause and menopause so doing regular yoga practice can also be beneficial for these. Some women find it helps reduce hot flushes too.
We also have a counsellor, sleep expert, pelvic floor physiotherapist and psychosexual counsellor working in my clinic. One of the advantages of working as a team with other experts in my clinic is that women can see different people to help improve their health in my different ways. Other clinics also work closely with similar experts.
9. Men will not be neglected!
Testosterone is the most important sex hormone in men and can lead to difficulties with erections, reduced libido, low mood, reduced energy and fatigue. The British Society of Sexual Medicine (BSSM) have produced guidelines about diagnosing and managing testosterone deficiency in men. We are very privileged to have Prof Geoff Hackett working with us who is a past president of BSSM and leading authority on testosterone replacement in men.