Welcome
This new service is run by Dr Juliet Balfour, who has been a GP at Glastonbury Surgery for many years and is a British Menopause Society recognised Menopause Specialist with the Advanced Certificate in Menopause Care.
The information on this webpage is for both patients and health care professionals (HCPs).
The service is only available for patients who are registered with a Somerset GP. For a list of practices that can refer, please click on link: SOMERSET PRACTICES THAT CAN REFER IN TO THE SOMERSET NHS MENOPAUSE SERVICE
REFERRAL INFORMATION FOR PATIENTS
Many women with menopausal symptoms can be managed by their GP. If you are having difficulty accessing HRT or are unable to take HRT and meet the referral criteria listed below, you can ask your GP to write to Dr Balfour. She can give advice or, if indicated, a face to face appointment at the clinic. This is a limited resource so each referral will be triaged and hopefully lots of issues can be resolved via written advice to your GP. If you do not meet the referral criteria, please check whether your own GP surgery has someone with extra training in women’s health and the menopause who can help you.
The clinic is held at Glastonbury Surgery once a week, usually on a Wednesday. If patients need to be seen in the clinic, the first appointment will be face to face. You may be seen by Dr Balfour or another GP who is training to be a Menopause Specialist and is working alongside Dr Balfour at the clinic.
Follow-up appointments, if needed, will usually be via telephone.
All appointments will be sent out by text with an opportunity for you to indicate whether you can attend or not, and a telephone number to ring if you can’t make that date. If you are seen in the clinic, your GP will be sent a letter with the suggested treatment plan and you will be sent a copy of this.
Please note this service cannot provide urgent care and does not have the capacity to give medical advice directly to patients apart from during a consultation.
The referral email address below is for health care professionals to use. THIS IS NOT FOR PATIENT USE, ANY PATIENT EMAILS WILL NOT BE ACTIONED.
There is a symptom checker in the symptoms box below. You can download this and fill it in before an appointment with your GP or at this clinic.
Please see the boxes below for lots more information about the menopause and HRT.
REFERRAL INFORMATION FOR HEALTH CARE PROFESSIONALS
The email address (which only accepts nhs.net emails) for referrals is [email protected]
This clinic has been funded as a 1 year pilot for 2 sessions a week. The clinic will give clear advice on HRT prescribing for GPs but will not be issuing prescriptions. If blood tests are needed eg for testosterone monitering or oestradiol levels, the clinic will ask the GP practice to do them and the patient will need to have the results available to discuss at their appointment. Please note that Dr Balfour is a Menopause Specialist but not a gynaecologist so any gynaecological investigations will need to be initiated via the GP.
All letters will be triaged by Dr Balfour to decide if the patient can be managed with advice and guidance or if they need to be seen face to face. Due to the potentially large number of women needing this service, the aim will be to provide a detailed management plan to the GP via letter when suitable and if Dr Balfour has enough information from the letter. If complicated or needing detailed counselling about options, benefits and risks, then the patient will be sent an appointment via AccuRx text to be seen in the clinic.
Information needed for the referral:
- why specialist advice is needed
- what the patient is hoping for
- if there is a particular reason why the patient may need a face to face appointment rather than advice and guidance
- what HRT has been tried before and at what dose
- a summary printout of past medical history and operations, medication, allergies, any blood results from the last 2 years
- if the patient is under 45, please check oestradiol and FSH levels 6 weeks apart if possible. If still having fairly regular periods, the first blood test should be day 1 to 3 of the cycle. You can still refer your patient even if the levels are normal. The progestogen only pill and Mirena do not affect FSH levels but there is no point checking FSH if on the combined pill or HRT.
- oncology letters if a history of breast cancer or a hormone sensitive cancer
- any letters from the Family History clinic
Please inform the patient that:
- they may not be seen in the clinic if appropriate advice can be given via advice and guidance
- the initial offer of an appointment will be sent by text
- due to increasing demand, A&G responses and waiting times to be seen are increasing
Patients suitable for referral for advice or appointment as appropriate:
- patients with complex medical histories when the HCP is not sure if HRT is a safe option e.g. significant active liver disease, a history of heart disease, VTE or stroke
- patients with complex gynaecological history eg endometriosis
- patients who have tried various HRT options but have not yet found something that works for them
- patients needing specialist advice on local oestogen options for genitourinary syndrome of the menopause (once other causes have been excluded e.g. lichen sclerosus)
- patients who would like to try adding in testosterone, if there is no HCP at the practice who has trained on how to do this yet. Testosterone for women is now green on Somerset ICB Prescribing Formulary if the HCP is competent to prescribe it
- older women (over 60 or over 10 years since the last period) keen to start or restart HRT if the HCP is not confident about current guidelines
- patients with premature ovarian insufficiency (POI) or an early menopause (see definitions)
- patients at high risk of osteoporosis or who already have osteopenia or osteoporosis
- young patients with possible perimenopausal symptoms but regular periods and the HCP is not sure about the diagnosis
- patients on HRT with unscheduled bleeding or endometrial thickening on pelvic ultrasound scan but only after advice has been sought from the gynaecology team and they have been appropriately investigated
- patients with a strong family history of breast cancer – please first check NICE guidelines in case they need to be referred to the Family History breast clinic for assessment of their degree of risk and to consider more regular screening and/or genetic testing first Clinical Knowledge Summary
- patients with a history of any type of breast cancer or another hormone sensitive cancer but only if not under the Bristol or Bath oncology teams (see below). This relates to breast cancer, endometrial cancer and some types of ovarian cancer. NB. Non-hormonal options are first line for these patients and will be discussed at the first clinic appointment. This will involve practical tips, lifestyle advice, and prescribable non-hormonal medication for vasomotor symptoms. Local oestrogen is usually an option, unless on an aromatase-inhibitor. HRT will NOT be prescribed at an initial appointment as other, safer options need to be tried first. There will have to be discussion with their oncology team if HRT is being considered. Please make sure your patients are aware of this before the referral to manage their expectations
Patients not suitable for referral to this service:
- patients with premature ovarian insufficiency or early menopause who mainly want to discuss fertility issues
- patients with unscheduled bleeding on HRT – these patients can be referred to the menopause clinic for advice on adjusting their HRT but only AFTER they have been investigated by the gynaecology team to exclude pathology – there will hopefully be more guidelines on this in the future
- patients with breast or gynaecological cancers who are already under the Bristol or Bath breast or gynaecological oncology services. These patients should be referred to the combined oncology and menopause clinic at the relevant hospital:
University Hospitals Bristol – Above and Beyond Combined Menopause and Oncology Clinic
Royal United Hospitals Bath – Macmillan Combined Specialist Menopause and Oncology Clinic
More general information for both patients and health care professionals
