Dr Shade Agboola, Director of Public Health will provide a presentation to the Committee on menopause services in Warwickshire.
Minutes:
The Committee received a presentation from Dr Shade Agboola, Director of Public Health. The presentation covered the following areas:
• Background/context outlining the request from the Committee’s Chair
• There is a lack of visibility of the services provided. What services are provided across Warwickshire and are the services equitable across the whole County, or do they vary for each ‘place’?
• What are the access arrangements? Are services provided at times convenient for women who work?
• Anecdotal feedback from a constituent told by her GP that she would not receive treatment until one year from her last menstrual cycle. When should services be available and how easy is it for women to get a referral? Does this vary for each GP/ area?
• There is an education piece. Schools educate on puberty and many aspects of the reproductive cycle. Should this include reference to the menopause?
• Are there triage arrangements to other services where required, such as CWPT for psychological impacts of the menopause?
• What roles do Public Health provide in regard to menopause services?
• Why important
• The menopause is caused by a change in the balance of the body's sex hormones, which occurs as women get older
• It’s a natural part of aging in women
• It happens when the ovaries stop producing as much of the hormone oestrogen and no longer release an egg each month
• Menopausal symptoms can begin months or even years before periods stop and last around 4 years after last period, although some women experience them for much longer
• Symptoms
• Most women will experience menopausal symptoms. Some of these can be quite severe and have a significant impact on everyday activities
• Common symptoms
• When to see a GP
• Troubling symptoms or symptoms of menopause before 45 years of age
• Can confirm if menopausal based on symptoms, but a blood test to measure hormone levels may be carried out in women under 45
• Treatments
• hormone replacement therapy (HRT) – tablets, skin patches, gels and implants that relieve menopausal symptoms by replacing oestrogen
• vaginal oestrogen creams, lubricants or moisturisers for vaginal dryness
• cognitive behavioural therapy
• eating a healthy, balanced diet and exercising regularly
• Referral to menopause specialist if symptoms do not improve after trying treatment or if unable to take HRT
• What’s available in Warwickshire?
• Menopause specialists
• The British Menopause Society is a specialist society associated with the Royal College of Obstetricians and Gynaecologists https://thebms.org.uk/
• British Menopause Society specialists are health care professionals that have been awarded additional qualifications.
• All BMS specialists are encouraged to become menopause trainers
• An online directory that provides a list of menopause specialists across the country
• Menopause specialists in Warwickshire
• There are two specialists listed in the online directory available at https://thebms.org.uk/find-a-menopause-specialist/
• They are both private providers
• There is no NHS provision in the County
• There are a number of specialists who provide NHS funded care in neighbouring Solihull, Birmingham and Coventry
• WCC menopause policy
• Menopause guidance for managers published in 2018
• Refers to a WCC menopause support group
• Acknowledges impact menopause may have on work
• Next steps/discussion
The Chair reported her concerns on the findings, expressing that for some women the impact of menopause could be traumatic for years. She explained her research to date including anecdotal feedback received, the symptoms reported to her and those experienced personally. There was an absence of services which was not acceptable, and half of the population would go through the menopause. There was a need to agree actions to address the current position.
A lengthy debate followed with the following contributions and themes:
• Concern and astonishment at the lack of services provided.
• Some surgeries did have GP’s who were skilled in addressing menopause problems. It was questioned if this was commonplace. In terms of specific provision, it was knowing when and how to access services such as gynaecology. The first point of contact was the GP.
• Reference to the private providers located in Leamington and Stratford. The cost of accessing their services was £180 for an appointment. This cost was not feasible for those in financial deprivation or unable to access the services.
• Accounts of the difficulties experienced by constituents with multiple challenges and the prescription of antidepressant medication instead of treating the menopause symptoms.
• The importance of raising this topic, which affected half the population. It had not previously been discussed adequately. There was a lot of discussion now via social media, with members of parliament and celebrities raising the profile of the menopause. A need to educate, also to take a holistic approach to treatment of this natural stage of a woman’s life. Reference also to cultural aspects and the need for employers to be audited, to assess if they had menopause protocols in place.
• For some women, the menopause caused anxiety or other conditions impacting on heir careers.
• Many women may deal with the menopause in isolation. A need for services to be provided across the county and not be reliant on the two private providers in south Warwickshire. Having a specialist located at GP practices was suggested.
• A suggestion to form a task and finish group (TFG) to explore this in further detail at the conclusion of the current TFG on GP services. This could include mapping existing services and the pathways in place. A useful outcome from the TFG would be a report back to the Health and Wellbeing Board, especially detailing areas of good practice identified.
• The impact on the male population too in terms of relationships and supporting partners.
• Wider changes to health systems, including the new Integrated Care System (ICS), health inequalities and identification of priorities at the ‘place’ level. The menopause could be raised as a priority area.
• Rebecca Bartholomew of Coventry and Warwickshire CCG agreed there was an absence of specialists in Warwickshire, but there was medical knowledge. It would be useful to provide clearer information on GP practice websites of those doctors who had additional gynaecology qualifications. She agreed to take this point back to the CCG. Rebecca also spoke about access arrangements, the need for all employers to have bespoke policies to support menopausal women and the employment difficulties experienced by some. Such policies did exist for maternity and should for menopause. A new initiative was a regional ambassador for women’s health, as an expert by experience. It was perceived that there was a shift towards providing specialists for menopause amongst other areas.
• A need to start with GPs to ensure there were menopause specialists available. Discussion about the comparative provision elsewhere, there being such providers in Solihull, Coventry and Birmingham.
• Considering the education aspects and raising awareness of menopause to pupils at secondary schools. A need for this to be ‘normalised’. Nigel Minns confirmed that that the curriculum did include the menopause.
• Accounts of poor support from GPs. A concern that HRT was not being prescribed due to suspected links to breast cancer, which had been disproven.
• Having specialist GPs for every subject was not feasible, but a ‘go to’ person located at each practice with capacity to provide information on a range of topics would be helpful.
• HWW found it surprising there was no specialist menopause provision in Warwickshire, unlike some adjacent areas and would look into this. HWW had undertaken work on care for women experiencing menopause. There were race, faith and cultural aspects which the TFG should take into account as part of its review. An offer from HWW to support the TFG and provide its evidence.
• There were mixed messages about not medicalising menopause, but then people were asked to see their GP. A need for clear messaging and consistent advice. Concerns that some women may self-prescribe.
The Chair asked the committee to think about next steps. There was support for the suggestion of a TFG at the conclusion of the current GP services TFG. She suggested that the scope included review of the comparative service position elsewhere and the quality of service provision. Additionally, she suggested a referral to the HWBB for consideration of this matter and that a letter be sent to the Secretary of State for Health and Social Care to seek a ‘top down’ focus. Further comments were submitted:
• The Secretary of State had announced that HRT would be available without prescription. Discussions were happening on menopause in government, so it was opportune to engage at this time. A need to ensure that Warwickshire got its fair allocation of resource to address the current inadequate provision.
• Comments on the potential risks of HRT being available over the counter, if suspected menopause symptoms were something else and it may not be a suitable medication for women with some other medical conditions.
• A member proposed to lobby her local MP on this topic and urged others to do likewise.
• It was requested that the TFG membership be drawn from the whole Council membership.
The Chair sought endorsement from the committee on the proposed way forward.
Resolved
That menopause services are also referred to the Health and Wellbeing Board for further consideration.