Menopause symptoms: can a health professional help? An interview with Dr Heather Currie -
Interview by April Cashin-Garbutt , MA (Cantab)
Dr. Heather Currie [1945015leadersd'opinion] SERIES ... insight of world AOS leading experts
what is a recent survey shows the number of British women who consult a health professional about their symptoms of menopause?
survey showed that only 50% of women consulted a symptom of health, despite the fact that many women said their symptoms had a significant impact on their professional life, social life, family life and sex life.
In our survey, 35% of women reported menopause significantly affected their work. He has affected their operation, performance and trust.
If women do not have significant symptoms are too bothersome, then it, AOS ok if they do not have to ask for help. However, it's not just the fact that 50% did not seek help, it is the number of women who had symptoms that affected, but apparently does nothing about it.
Does the investigation is why women do not seek help?
He did. Some women do not think the symptoms were pretty bad and some of them felt they had just put up with it and just accepted as a normal part of life.
Some women felt that if they go to the GP, all that would happen would be that they would be offered hormone replacement therapy (HRT) and many women have expressed concern about the use of HRT.
Have you been surprised by these results?
Given the NICE guidance for menopause were released in November and generated a lot of media coverage in the UK, we, AOD hoped more women claiming they were looking for help and recognition and support of information out there for them, but the survey highlighted the scale of the educational challenge remains to ensure that women aren, AOT suffer in silence.
Can you please preview the recently published guideline on the diagnosis and Nice menopause management?
There are different sections. The first concerns the importance of women to obtain information. He is aware that women and health professionals have received very mixed messages over the years, whether from research studies or media reports. There has been much confusion about the effects of menopause and how long the effects can last as well as the benefits and risks of different treatments.
women should have access to accurate information , which is why we have developed websites and updated resources, including online resources. We, AOVE provided many tools to help women get the right information.
The next thing is stressing the importance of individualized because no two women are the same . How menopause affects women and what are the rules for the different changes or dietary treatments and lifestyle, is very individual. Moreover, even within a woman, it is important to know the stages of menopause and how menopause affects sound may change over the years, which in turn also affects its needs treatment.
Regarding the diagnosis of menopause, the message is simple for women aged over 45 who have symptoms of menopause as a change in periods or periods of absence, we n does not need to do a blood test. In the past, blood tests were often made to measure hormone levels and we believe that for many women, it is not necessary. As well as the cost of the blood test, there is also the need for further consultation to discuss the results, which means that it is often a delay in the start of management because they expect results. The practical thing is to do blood tests to diagnose menopause less.
There are tips on women being aware of the recommendations on diet and lifestyle changes, both to reduce early symptoms and also to improve their long term health. The information is needed to help women understand the stages to go through perimenopause and menopause, the range of symptoms that can occur and what treatment options are available.
For the treatment of symptoms such as hot flashes, night sweats, mood and low recommendation is to offer HRT. For most women, the benefits of HRT outweigh the risks.
There are also some details about the benefits and long-term treatment of risks, but the first symptoms, the clear message is to offer HRT. At present, there are many women experience symptoms that have a great impact on their lives and who could benefit from treatment, but access to treatment because of the perceived risks of HRT.
One of the resources we 've developed is a Infogram on perceived risks and also the great thing women worry about, what is the risk of breast cancer. We compiled a very useful chart that shows the number of women and waiting estimated breast cancer associated with HRT, and its association with alcohol consumption, particularly obesity, which is a risk factor much greater than the use of HRT. message about breast cancer is that HRT does not cause cancer, but can promote the growth of cancer cells that are already present in some women.
Regarding the duration of treatment of another message is that there is no arbitrary limit. Often in the past, if women took HRT, they were told they would have to stop at some point. In fact, it is the woman. If taken for the symptoms, you can never predict how long the symptoms last, so you can not predict how long the treatment will be required.
The British Menopause Society website is intended for health professionals, but we added in the first ten messages to summarize the NICE guideline to help people access information.
do you think these guidelines will encourage women to seek help?
is the first thing most women to get information. However, there is concern that primary care in the UK is under enormous pressure, so we do not want people to think that we encourage many more women to go to their GP and GPs will be even more flooded.
The point is that if women have access to information using, for example, the various resources available to help them, so if they go to their health care professional, they can have a discussion much more useful. You can not cover all of the information that is needed in a short appointment, therefore, inevitably, that could lead to another appointment. However, if women can already be informed when they go, they can have a more informed discussion, which can be really useful.
Once women got the information, it may be that some of them are actually able to make diet and lifestyle changes and perhaps all that is necessary. However, if they need treatment, then they would need to go to a health care professional to have that prescribed or they may want to have another discussion. Anyway, it would be useful for them to have some information first.
How do you plan to raise awareness of the Nice guideline?
the launch of the campaign in May was the first part of the awareness and we want to continue to provide education. We provide the education of health professionals across the UK Menopause Society. We have a whole program of scheduled meetings and a publication that goes out to all our members.
For women, the campaign has received much media attention. It was great, but we also have things to come in long lead publications, so we have other stories of menopause that are coming over the next few weeks and months or more. We hope that the use of our websites and range of websites increase. We also use social media, just to keep the message. It is a case of type drip feeding the message really keep up consciousness; not only aware of the NICE directive, but awareness of the importance of menopause.
What misconceptions that people have about menopause?
First of all, I think many women focus on the symptoms and they expect that the majority of women who have hot flashes and sweats. One misconception is that it is about hot flashes and sweats and what we are trying to educate people about is that menopause is all about a lack of estrogen. Women organisms, AOS become weak on estrogen because in the majority of cases, our ovaries cease to function. In some women, the ovaries can be removed or could be affected by other treatment, but regardless of the type of menopause, it is, it, AOS all related to the lack of estrogen.
What strengthened our survey is that there are often symptoms that women do not expect such as low mood, sleep disturbance, and joint pain, even if they are also very common. We try to get people to understand other effects of estrogen deficiency. Also, because we are living longer, we are going to live longer with the consequences of estrogen deficiency.
When people focus only on flushes and sweats, they don, AOT include subsequent effects. Women often experience vaginal dryness and discomfort and bladder problems such as urinary tract infections and going to the toilet more often or more urgent and all these things can be related to the lack of estrogen. The lack of estrogen also affects our bone and heart health. Therefore, the misconception that it is about hot flashes and sweats, means that we lack all other important information.
I think the other misconception is that the first symptoms only last a short time, so we saw a lot of women who just put up with it, thinking, "Oh , it will be fine. it will not last long. "However, we now know that for many women, these symptoms start early can last long. The first symptoms are resolved in many cases, but we know women in their 70s 80 and still have them.
in addition, among women whose symptoms do not resolve, then they think, "Well, I 'm through menopause now. "If you focus only on shutdown periods, hot flashes and sweats, then you do not have this understanding that the body is changing, and our bones and heart health, and therefore we have need to stop smoking, increase exercise and lose weight, if any, to also improve the long-term health.
There are not really such thing as "I'm through menopause now." It is really thinking, "Okay, I stopped to have flashes, but my body is still low on estrogen. What can I do to help this? "
Regarding salaries, the biggest misconception is that HRT is risky and dangerous, when in fact, for most women, there more benefits than risks.
what are the benefits and risks of HRT?
the great advantage is that it is still the most effective treatment to control symptoms that occur due to estrogen deficiency. We know it is good for bone health, and if HRT is taken, it can reduce the risk of osteoporosis and osteoporotic fractures. Although he didn, AOT come from the NICE Directive, another point is that there is more evidence suggesting that there could be a benefit on heart health if HRT is started early in the menopausal stage
We used believe that 15 years ago, and women often took HRT for this service, even if they didn 't have symptoms. However, a publication that has changed that view on HRT was an American study which was published in 02. Since then he has been re-analyzed several times and people are back to thinking that HRT is in the early probably protective against heart disease. It was seen as a risk, but in fact it is probably more likely to be an advantage.
It is well established and very slightly increased risk of having a DVT or blood clot when taking the form of HRT tablets, so for women with risk factors for people, like being overweight, we recommend the use of estrogen is absorbed through the skin, which is either in the form of a patch or gel. Administration by this route has not the same effect on our coagulation system.
Then, the big concern is the risk of breast cancer. Current understanding is that HRT does not cause breast cells to turn into cancer, but some types of HRT can promote the growth of cancer cells that are already there if taken for more than five years after age 50 years
The important point here is that we have identified. All women have a risk of breast cancer for individual baseline; two women have different risks of developing breast cancer. It is a myth that HRT causes cancer. It can promote the growth of cancer cells already present in very small numbers in some women. However, there are certain types of HRT and, against this are the advantages that we have described.
What needs to be done to educate women about the information and support available?
We want to get the word out there as much as possible. There was a lot of press interest in May, which was fantastic and a little since then, so it continue. There are possibilities of radio programs and I was on one of our television program recently, which was great.
We have various avenues for the use of social media. We're just trying many different ways to get the message to women. There are websites that I just mentioned and I also publishes a magazine Questions of menopause.
We are pleased to work with patient organizations. Since last week, we heard a couple of people who are eager to start group sessions for women, we are also happy to help with. We help in any way we can really.
What do you think the future of the management of menopausal symptoms?
I believe that HRT has many benefits. Not all women would be advised to take HRT. For many women, simple things such as diet and lifestyle changes can really make a big difference, but for those who want specific treatments, I will always think I have a lot of myths about the risk of dissipating and that we must give women accurate information so they can make informed choices. At present, many women still make decisions based on old information or the myths that I have just mentioned.
Since we know the consequences of estrogen deficiency, it makes sense to have a useful treatment that will bring estrogen back and replace what our bodies have stopped producing. We know there are many benefits. We know it's not perfect; I do not think that any medicine is perfect, but now there is research looking at how we can maximize the benefits and absolutely minimize risk.
The risks are already very small, but there is more interest in different ways of replacing estrogen as safely as possible. We need more scientific research on this subject, but we have new preparations that will hopefully begin to appear.
Diet and lifestyle are extremely important. There are alternatives that can be helpful, perhaps then we need more research on them. There was a concern about the standardization of products and the products we buy over the counter are not regulated in the same way as prescription drugs. We could do with more information about these preparations, so that we are able to trust what is in them. We still need more research.
What, AOS your vision for the British Menopause Society?
The objective of the British Menopause Society is to support and educate health professionals. In the UK, the majority of care is provided in primary care, so that in primary care, we would like to be a general basic understanding of menopause and treatment options that the Nice Directive has given us.
We just need to continue to provide simpler versions of it. The complete document is huge and busy doctors and nurses in practice it is unlikely to read it, so we have provided a summary and key messages. It is about women getting consistent information. How are they notified should not depend on where they live or who they see. Although we must individualize, there are some basic messages we want to be consistent.
One aim of the British Menopause Society is to support education in primary care, but we will be like a menopause specialist service within each region. Some women may have complex medical histories that could mean side effects of treatment, in this case, it needs to be someone that primary care can refer. Whether it refers to the patient, whether e-mail advice, a phone call or anything, support must be provided at a specialist level.
What we want to do is work in the country, looking at how we can help people get the proper education. We have training courses to get to this level of specialist, so that there can be specialized services within each region. To do this, we must also work with commissioning groups. It's part of the idea to raise awareness of the menopause, to try to promote the funding to provide these services.
Where can readers find more information?
is the British site Menopause Society, which is intended for healthcare professionals, but it is also related to the concerns of women's health, which is patient charitable arm of Menopause Society in the UK.
In addition, there are issues of menopause and publish a magazine as well. It is quite a new website called managemymenopause.co.uk, giving women a more suitable information. This allows people to put in their history, their situation and then print more than one sheet of individualized advice.
For women who have premature menopause, there is a support group called Daisy Network, which is specifically for young women. They are all linked together and complement each other. They all offer something different and we do not mind that women use. They might want to look at all and they are all really helpful resources.
About Dr Heather Currie
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