Feversham Lane, Glastonbury, BA6 9LP
01458 833666

Somerset NHS Menopause Service

 

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 

Definitions

  What is the menopause? The menopause is defined as when you have not had a period for one year (as long as you are not on medication that could ... [continue] Definitions

Symptoms

  We have oestrogen receptors all over our bodies, including our bones, brains, heart, skin, bladder and vagina. There are many possible symptoms related to the menopause, some more commonly ... [continue] Symptoms

Genitourinary syndrome of the menopause

This is the new name for the vaginal, vulval and urinary symptoms that many women suffer from. They can be the first symptom of the perimenopause or not develop until ... [continue] Genitourinary syndrome of the menopause

HRT information

  What type of HRT can I have? If you have had your uterus (womb) removed you only need oestrogen HRT. If you still have your uterus you need both ... [continue] HRT information

Prescribing information for testosterone

Most doctors do not have any experience of prescribing testosterone for women. However, the NICE guidelines (NG23) do indicate that some women may benefit from adding in testosterone if their ... [continue] Prescribing information for testosterone

Hormonal Blood Tests

Most women do not need hormonal blood tests to diagnose the menopause. If you are aged 45 or over and you have menopausal symptoms, you do not need any hormonal ... [continue] Hormonal Blood Tests

Resources for patients

  Recommended websites www.womens-health-concern.org The patient arm of the British Menopause Society, includes lots of useful factsheets. I recommend the one on breast cancer risk factors and the chart on understanding ... [continue] Resources for patients

Resources for Health Care Professionals

The British Menopause Society: thebms.org.uk Women’s Health Concern: women-health-concern.org Primary Care Women’s Health Forum: pcwhf.co.uk Somerset Prescribing Formulary: formulary.somersetccg.nhs.uk  

Myths about the menopause

Here are some of the myths about the menopause and HRT. Many of the perceived contraindications to HRT are based on the flawed Women’s Health Initiative study published in 2002 ... [continue] Myths about the menopause

Patients with a history of breast cancer or another hormone sensitive cancer

Cancers that are hormone sensitive include most types of breast cancer, endometrial cancer and some types of ovarian cancer. Treatment for many different cancers, not just the hormone sensitive ones, ... [continue] Patients with a history of breast cancer or another hormone sensitive cancer

Unscheduled bleeding on HRT

This is a very common problem for both HCPs and patients. It is not unusual to have some unexpected (unscheduled) bleeding in the first 3 to 6 months after starting ... [continue] Unscheduled bleeding on HRT

Symptoms of gynaecological cancer (red flags)

Here are the symptoms and signs of the 5 gynaecological cancers. It is important to be aware of these symptoms. Please discuss them with your doctor who can arrange the appropriate ... [continue] Symptoms of gynaecological cancer (red flags)

Contraception in the perimenopause and menopause

If not on HRT or hormonal contraception, the rules are: If under the age of 50, can stop contraception 2 years after the last period. If over the age of ... [continue] Contraception in the perimenopause and menopause

Alternatives to HRT

Not all women need or want to take HRT. Most of the symptoms do settle eventually but it is very variable how long they last. The average is about 7 ... [continue] Alternatives to HRT

The importance of lifestyle

Lifestyle improvements can play an important part in helping you cope with perimenopausal and menopausal symptoms. They can also improve your long-term physical and mental health. HEALTHY EATING AND OBESITY ... [continue] The importance of lifestyle