Menopause clinics

I think from my point of view as an oncologist, I would consider that most women who are, all women who are not benefiting from the interventions that we make in oncology should be seen by a post-menopausal clinic and have these issues discussed at a greater length.

Sure, and so basically when the menopause becomes the large issue for the woman you would tend to refer on to specialists.

I think so, because you know there are women who kind of really do go through menopause unaffected, which is wonderful to see, they seem to be few and far between, but they can be young, they can be old. So, you know as long as we are keeping an eye on her bone health, and she is managing her weight and doing her exercise recommendations, I don’t see a particular reason to send this woman to the menopause clinic. But then when I see a 36 year old who feels that her life is destroyed by having this treatment and who is thinking about whether she can go through it for one or two years, let alone five or 10 years, I think “Well, this woman needs pro-active management to get her as well as we can.”

I think an advantage of sending people to a menopause clinic is for women to be reassured that they are seeing a specialist in menopause whose primary concern is their menopausal symptoms not their cancer. That is a good thing, because I think patients can be reluctant to talk to their oncologist about how bad their oncological treatment is making them feel. So, I absolutely think there is benefit.

So we tend to refer the patients, the 10% to 20% that are the really difficult, struggling patients to people. For example [women’s health clinic]has a menopause clinic service and has lots of information and we would always give them the information about [women’s health clinic]. There’s a bunch of female endocrinologists now that tend to specialise in this area but you’d be surprised how few there are to be honest.

It’s not, despite the fact that 50% of the population get menopause, or 50, a bit more than 50, you know there’s not really a lot of people that specialise in the area. So it is challenging to get a lot of people in and we tend to get the harder ones to go and see people. And the ones that are less than that, but use some of the resources that are out there like [women’s health clinic]and those kind of things in combination with their general practitioner and some of the GPs are really good as well.

There’s hardly any of them. They’re very hard to access. There’s a handful of them. They’re basically for women in very specific scenarios and often from specific geographical areas. I think they’re excellent services. There just needs to be more of them.

Do you know of any of them in regional or rural areas?

I don’t think there are any. In terms of endocrine services going east to the last point of call would be [regional town] and there’s a clinic there once a fortnight, which is general endocrinology. Going the other way you’re probably looking at [regional city]. There may be some outreach clinics a bit further along. But there’s very limited specialist care in a lot of rural areas for anything, let alone something like that.

There’s certainly too few menopause clinics, and that goes back to the panic which occurred in 2002 upon the release and misinterpretation of data from the Women’s Health Initiative, and I think a lot of clinicians lost interest in menopause. A lot of women were reluctant to ever see a doctor with anything to do with menopause. A lot of family doctors stopped doing anything to treat menopause because they thought it would be harmful for their patients.

So in [place name] there are very few public menopause clinics, and so we obviously have a bit of a waiting list. We send out letters regularly to all the GPs that work in our area and explain to them any changes in our service and remind them of the services that we offer, which change from time to time. So we’re about to add an adolescent gynaecologist as well, which is again somebody who may be particularly suited to seeing the younger women in this population that we’re talking about today.

But yeah, I think it’s difficult, because there aren’t enough clinics available for women to attend.

This is one of the things with the public hospital clinic is people keep getting more appointments. So what you should be doing is saying, “This is what we’re going to do for you,” you get them back, you see how they’re going. If they’re going okay, you discharge them, and you say “You can come back if things deteriorate,” you hand them back to the health professionals that are already looking after them. Here’s the recipe, so you can bring in more new patients, because new patients need the intervention.