Menopause

Well for instance when I went for my flu jab there’s the main waiting room for the doctors and all of the posters up there are about flu jabs and about NCT [National Childbirth Trust] for childbirth and there was nothing for menopausal women. Whereas when I went round the side into a little closed corridor where the nurses’ offices are, where you go just for the jabs, there’s a tiny word processed poster advertising a menopausal discussion group. And just by the mere act of downplaying it onto just a word processed page and sticking it on the wall out of the way, makes you feel as though this is something that the GP’s surgery doesn’t consider to be a priority. It’s not something they want to recruit loads of women to. It’s not a service they want to push. And therefore if I was to say I’m interested in it, what sort of service would I receive, what other women would go for it and how would I be viewed by the healthcare professionals? It just didn’t send me the message that the changes that I’m going through are important enough for the surgery to take forward and so it didn’t entice me at all.

How do you feel about that?

I feel that they’re missing a picture. I think that for me I’m okay, I’ve got a supportive husband, I can do research on it if I want, I’ve got support groups amongst friends if I choose to pursue that but for other women this may not be the case. And I think it’s a service - I mean fifty per cent of the population are women, a hundred per cent of them are going to go through the menopause at some point. There’s nothing on the T.V. about the menopause. It’s something that society just pushes out of the way and it’s a reflection of the value that they place on older people in general and women in particular. And it’s a very important issue to deal with. I would imagine that for some women it can lead to significant levels of depression. The change in how you perceive yourself, how society perceives you and also the hormonal changes in themselves may engender some sort of endogenous type of depression and depression amongst the elderly is a significant issue for PCTs [Primary Care Trusts] so I think it’s an area which is very overlooked and should be addressed.

So what sort of information do you feel they should be providing and what sort of services do you think would be helpful?

I think they have to normalise it first and say every woman will go through the menopause at some point, that this is perfectly natural, it’s nothing to be frightened about, it opens up new opportunities rather than it is a loss of a particular phase but it’s an opening up of new ones and to put it across in a much more positive and upbeat way rather than a little grey poster on a wall saying “do you want to talk about your menopausal experiences?”. I think a support network is appropriate where you can meet people that you don’t necessarily have a friendship with but you’re just there because you’re menopausal and that in itself is self limiting in how you feel you’ll be perceived. You go along because you want to be perceived as a menopausal person but with your friends you don’t want to be necessarily seen as that. So that sort of peer group support is appropriate but with informed input from the professionals who know about this and if there are particular health issues which are arising as a consequence of the menopause then those can be identified and dealt with appropriately.

I think there are a number of issues. Firstly, in general practice we’re so focused on government targets, which we have to do. The government is pelting us with targets on things like cardio-vascular disease, diabetes, asthma, cancer, mental health that menopause is a Cinderella subject. We get no payment for doing it and so a lot of GPs have it as an extraordinarily low priority and really I happen to have an interest in it both personally, because I’m going through the menopause and I’ve been working in this area for twenty years. So I have that knowledge base, which I’ve found personally very helpful to keep me on a even keel but I think most GPs, to be honest, don’t have the time, don’t have the interest, don’t have the information in their minds about all this. And often I find women coming in who’ve read some excellent websites or books are actually much better informed than the average GP and that’s nice because you educate us as you come into the surgery. But quite often we don’t support women very well.

Well I suppose I’ve seen both sides of the coin haven’t I. I’ve had the experience with the first lady doctor who made me feel very stupid and made me feel like I was wasting her time by going and that is not on.

But you just have to have choices and when you’re menopausal and going through the menopause it’s very easy to let your choices go. It’s very easy to be led by doctors and nurses and friends as well who let you down. I just feel that the medical profession needs to have a broader view of things because every woman’s menopause is different and it affects them in a very different way. It takes over their life and it’s there day in day out and it’s a pain in the butt. But it’s going to stay with you for a long time. And it was so refreshing to see this second doctor, I mean she listened, she asked questions, and she advised and she made suggestions and it just gives you hope. Rather than having the door slammed in your face saying one of two things, you’re depressed or it’s the menopause get on with it.

I think the important thing is that every woman is an individual and you can’t say “Oh well, the last ten that I’ve seen this has worked for” you’ve got to treat each individual case differently. Listen to what the woman’s saying because nine times out of ten that woman’s already gone and looked it up for herself, she’s gone to the doctor because she’s getting at the end of her tether and she realises that she’s got to go and talk to somebody that’s supposed to be a professional and knows about these symptoms. And I think sometimes they don’t, they don’t have enough patience with you, they don’t sit and listen to you and perhaps give you a bit of sympathy. Because sometimes it’s just the woman wants to talk and just talking to somebody.

What do you think women need?

I think they need access to information to reassure themselves that they’re not going mad, that it’s self-limiting and it will get better. Because I think women put up with everything all through their lives and they just want to know, “Is this normal? Am I in the realms of normality because I’ve never felt like this before.”

People often come in, sit down in my surgery and say, “I think I’m going mad.” Or, “I’m worried I’m going demented like my mother did.” And actually that reassurance of, “No, you’re not mad. You’re not abnormal. This is the menopause. It will get better.” Is all women want and then they’ll get on with running Marks & Spencer, looking after their husbands and everything else that we do all the time.

I think if they’ve got any literature they should really be giving you the literature at an early stage so like when I went and said that my periods were starting slowing down and stopping that if I’d had information about what this might be. So that you could say you might be going through your menopause, these are the symptoms to look out for, and then talk about the different sorts of treatments like what is HRT, so that you know what it is so that you can actually kind of plan your menopause in a sense.

And the NHS is not structurally, it’s not possible under the NHS to get the right information to everybody when they need it. It’s just logistically almost impossible. I think the one place where it would be really, really useful to get the information would be from a pharmacist. I think pharmacists are a very underused resource. They have a vested interest in making sure that their customers have the information that they want, they get the drugs that they want. They’re a very accessible place to go because if you go into the surgery you’re going to run into various neighbours because you live in a small community and people are going to see you and they’re going to say, “Oh, she’s in the surgery. I hope she’s all right. I wonder what she’s in for.” Go into Boots. You’re going to buy a shampoo, you’re going to buy foundation and you’re going to go and talk to somebody about menopause. It’s just a more accessible resource. I’ve thought for ages actually that pharmacists are very well trained, very highly trained. And I would like there to be more. Even little consultation rooms, little cupboards where you could go and just say, “I’ve been on this HRT for about three years. I really don’t think it quite suits me. Is there something else I could get?” I’m not suggesting they take over from doctors but they could say, “Yes, there’s this kind and these side effects and those side effects and those side side effects. Have a look through that and then go and see your GP and he might be able to prescribe something else.” It takes less time from the GP and makes it easier for the person too.

My sense is that a lot of us just don’t understand the process that we’re in and we’ve all got a lot of questions and they might seem small naive little questions but they need to be answered. And because you feel the GP’s time is so limited I would have welcomed I think an opportunity to be referred to the specialist nurse just to talk to her. In fact I prefer talking to women so if the GP had said “do you want some advice on menopause, do you want some discussion about it, have you got any questions? Well you might like to make an appointment with the nurse”, then, and I’m assuming a gender thing here which I probably shouldn’t assume, but probably our experiences guided me there. But an opportunity like that would have been good. I notice that in my healthcare centre there are other sessions available on other conditions where there is some nurse intervention or some small group are brought together. I think that might be valuable. At one time the Family Planning Clinic acted like a kind of Well Woman Clinic in [place]. I don’t know if that provision is elsewhere. But it’s since changed because of lack of resources and everything it’s mainly about contraception now but that model that you could make an appointment and go to a session where there were women who were having advice on contraception and general healthcare, that would have been great.

I suppose well, it’s a bit unfair because probably if there was a menopause clinic, that sounds terrible, and probably there is because if I went in and asked the practice nurse in one of these the information is probably there. But you tend not to until you’re called because it’s your smear test is due or you’re due an MOT if you like. I’m not sure if it would be worthwhile having one that’s actually entitled that, I mean it might put people off I’m not entirely sure. It’s like all these things I think if you want to ask or you’re desperate to know something and you ask the information will be there. It’s just for those who perhaps don’t want to put themselves out or feel awkward in asking that it’s not flagged specifically. It’s, and again a two edged sword, whether it’s entitled a menopause clinic or something would, “Oh, I’m not going in that door.” So there’s pros and cons for having it sort of specially.

Why do you think women wouldn’t go if you had a menopause clinic?

Well, some people wouldn’t. It wouldn’t worry me but some I would imagine wouldn’t like to sort of flout that they’re of that age. I mean I don’t know as I say it wouldn’t worry me in the least but that depends what door you’re going through I suppose from the big central area where everybody waits. I’m not sure what else you could call it though.

Why do you think they have that attitude towards it?

Well, I suppose some people don’t want to twig or to let on they’re of that age perhaps. I mean I’ve no idea. As I say, it wouldn’t fuss me in the slightest but I mean I presume some people also feel it’s the end of an era if you like, biologically. That’s it and maybe they don’t want to give off that signal. I don’t know.

I know I feel a bit of a fraud but I sailed through it really fortunately without the need for HRT or anything else.

I have said this to other people that sometimes I think doctors even forget that not everybody’s ill and that actually I’m sure I’m not alone in actually having had a good experience if you want to put it that way. And so sometimes I think you do need to put the good side as well and that you don’t necessarily all go into a decline and have a lot of problems. But I mean there was nothing I could do about it, it’s just that I’ve been fortunate, that’s the way it’s been for me but I say I’m sure I’m not the only one. It’s like doctors I’m sure sometimes think everybody’s ill because they only ever see people who are ill. So just bringing a bit of good news if you like.