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GPs should give all women menopause health check at 45, say MPs

GPs should give all women menopause health check at 45, say MPs

All women should have a health check to screen for menopause symptoms at 45, MPs have said, while also calling for menopause to be added to QOF.

In a report published today, the All-Party Parliamentary Group on Menopause made 13 recommendations for Government, including ‘implementing a health check for all women at 45 to help diagnose menopause at an earlier stage’.

The group also called for menopause to be included in QOF ‘to improve menopause diagnosis and treatment’.

The report said: ‘Witnesses also suggested that a menopause indicator could be included within the GP Quality and Outcomes Framework (QOF) which tracks disease prevalence and care quality achievement rates.

‘As a reward and incentive programme for GPs, inclusion of menopause on QOF’s could significantly help
resource and reward good practice.’

GPs should also receive training on menopause, the APPG said, although with the caveat that this should be for those who did not receive it in the past.

The report said: ‘While it is welcome that a Medical Licensing Assessment for incoming doctors will be introduced in 2024/25 and will cover menopause, Health Education England and the RCGP must consider how to equip existing healthcare professions to deliver the best menopause treatment possible through
primary care, such as through Continued Professional Development courses for existing GPs who
did not have the option to receive adequate training in the past.

‘The RCP, RCPsych, RCN and RPS should also ensure all their clinicians receive updated menopause training to allow correct diagnosis and treatment of the perimenopause and menopause.’

The APPG’s recommendations in full

  • Urgently scrap prescription costs for HRT in England, as is the case in all the devolved nations;
  • Implement a health check for all women at 45 to help diagnose menopause at an earlier stage.
  • Fund new research into the real benefits of HRT and the link between menopause and serious health conditions;
  • Co-ordinate an employer-led campaign and improve guidance to drive up support for menopause in the workplace;
  • Create a National Formulary for HRT and include menopause in the GP Quality and Outcomes Framework to improve menopause diagnosis and treatment;
  • Provide updated menopause training for GPs and other healthcare professionals who did not receive it in the past, in addition to the forthcoming medical assessment for incoming doctors.

Source: Menopause APPG

Announcing the report, which follows a year-long enquiry, menopause APPG chair Carolyn Harris claimed taboo still prevails around menopause within the medical profession.

The Labour MP for Swansea East said: ‘We are beginning to feel the tide of change but the taboo around the menopause still prevails in all corners of society – in workplaces, within families and among friends, in education, and in the medical profession.

‘The consequences for those suffering with menopause symptoms who can’t get the right treatment can be severe – leading to the break down of personal relationships and jeopardising careers, with women being forced to take additional days off or leave work all together, putting their financial situations at risk.’

In summer, the House of Commons Women and Equalities Committee recommended that GPs need mandatory menopause training and targeted communications around the HRT scheme.

This was also a recommendation made by the Government’s Women’s Health Strategy.

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However, GPs have pointed out that the RCGP curriculum includes women’s health training, with GPs tested on this via the MRCGP exam.

Ms Harris said: ‘Whilst the development of a Women’s Health Strategy was an opportunity to revolutionise access to menopause support and treatment for all, in its current form it has failed to address the multiple issues that women in the UK are facing.

‘Change is vital and we urge the new minister and Government to give the menopause the attention it is due and take forward the recommendations in our report for the sake of women across the country.’

APPG reports are not official publications of the House of Commons or the House of Lords and APPGs are informal groups of members of both houses with a common interest in particular issues.

A footnote to the report clarified that the views expressed ‘are those of the group’, and disclosed that it was ‘researched by DGA and funded by Bristol Myers Squibb and Astellas Pharma’.

Dr Margaret McCartney, a GP in Glasgow and a campaigner for evidence-based medicine, said this sort of recommendation should come from the UK National Screening Committee rather than APPGs.

She told Pulse: ‘Women need evidence-based, independent information and advice.

‘The report says “almost everyone that the APPG heard from during the course of the inquiry agreed that screenings of women over a certain age through the NHS could help improve diagnosis and treatment of menopause at an earlier stage”.

‘This is a truly dreadful attempt at trying to direct policy. Where is the evidence? The UKNSC should make decisions like this, everything has an opportunity cost and it may be a way of wasting money while not getting women the help they need.’

Professor Azeem Majeed, a GP and professor of primary care and public health at Imperial College London, said: ‘It’s important that  the recommendations are independently reviewed as there was support from industry for this report.’

And he added: ‘All new health interventions come with opportunity costs and these is little mention of how this work would be funded and the workload covered.’

The APPG’s demands come as there was a 35% increase in prescribing of hormone replacement therapy (HRT) last year, according to a recent report from the NHS Business Services Authority. In all, almost half a million more women were prescribed at least one HRT medicine in 2021/22.

At the same time, pharmacies have struggled with severe shortages. A report from the Government’s HRT taskforce in September said Oestrogel supply had improved but HRT products were still in short supply.

The Gina 10 microgram vaginal tablets (estradiol), which is the first HRT treatment available without a prescription, was made available by Booths last month, before being rolled out to independent pharmacies.


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Please note, only GPs are permitted to add comments to articles

ian owen 12 October, 2022 10:51 am

If there’s a 35% increase in HRT surely that implies we are doing a lot of that anyway? Although I suppose my grumble should be the absence of #7: find more clinical staff to do these checks

Truth Finder 12 October, 2022 11:10 am

If you look at all the groups, NHS health checks, vulnerable patients, over 75s, over 65s etc etc, everyone is “special” now meaning no one is. She is totally out of touch. There is no taboo for menopause or any condition. GPs do their best with the workload. Where’s the staff Carolyn Harris?

David Taylor 12 October, 2022 11:29 am

Surely rather than just seeing every woman at 45 for a health check specific to menopause (as far as I am aware all adults can have a health check then anyway for cardiovascular risk etc) we should continue to offer treatment to those that want/need it and potentially bring it up in their normal health checks. I do suspect that all the talk about the menopause can be a double edged sword – great that it raises awareness it encourages people to come forward for treatment if symptoms are debilitating but at the same time surely it just increases anxiety for those prior to menopause thereby increasing the chance that people will get significant symptoms. It seems to be forgotten that many women do go through menopause without the need or want for treatment.

Richard Greenway 12 October, 2022 11:33 am

I’m going to stick my neck out here.

I heard the MP on the radio who seemed very ill informed -stating that most patients are on equine oestrogens, and seemed confused about nature identical oestrogens /vs progesterone /synthetic progestogens which didn’t get a mention.

OK – National average age for menopause approx 51.
Yes peri-menopause for some time prior -we know this.
But what will we be checking for at 40-45? Evidence base please?

And GPs not trained. Really? Maybe just not enough GPs /GP resource.

And why free prescriptions for this group rather then people with hypertension, stroke, benign prostatic hypertrophy or depression? There is already a special reduced prepayment for HRT max £10 starting in April. Free prescriptions for all in England would be lovely, but don’t blame the GPs!

Cameron Wilson 12 October, 2022 11:36 am

Suppose they have to justify a year’s supply of prawn sandwiches and no doubt travel expenses etc !! Utter waste of time, and they can recommend all they want! It isn’t going to happen,furthermore Politicians should work on their own credibility before rattling our cages!!

Patrufini Duffy 12 October, 2022 11:45 am

Conscious bias. Or they could just go to GUM and have the service funded there.
No, that’s a silly idea.

Robert James Andrew Mackenzie Koefman 12 October, 2022 11:58 am

Good one for pharmacists to do or maybe 111

Long Gone 12 October, 2022 12:36 pm

Just the latest in a long and seemingly inexhaustible line of stories about GPs supposedly falling short and failing in their duty. If this is so important – which it is – then fund it properly. Certainly, menopause care is a complex and difficult subject that requires a longer consultation time than can currently be provided by our collapsing primary care resources. So look more deeply, think more deeply and above all take your head out of your political **se, Mr/Mrs/Ms Minister of Dunning Krugerology.
Pathetic, predictable and **ss poor.

Fedup GP 12 October, 2022 1:31 pm

“23% were given antidepressants, against NICE guidelines”

GP’s really are bastards aren’t they?

(From the BMS re SSRI’s
“In general baseline effectiveness

Fedup GP 12 October, 2022 1:32 pm

“23% were given antidepressants, against NICE guidelines”

GP’s really are bastards aren’t they?

(From the BMS re SSRI’s as an alternative
“In general baseline effectiveness

Patrufini Duffy 12 October, 2022 4:03 pm

There’s something sick going on in Western society. 18-40 year olds drunk on sertraline, lisdexamphetamine, propranolol, cocaine and cannabis. Splashed with aciclovir and azithromycin and a dash resistant to nitrofurantoin. Then they want you “tolerable” on testosterone and venflaxine. Progressive. Big business.

Andrew Jackson 12 October, 2022 5:10 pm

HRT has just become the latest simple solution to complex health presentations. These solutions are always attractive because they seem so easy. Far less people benefit than the initial estimation and many are left disappointed.
We had it with opiates, SSRIs and Vitamin D for chronic pain.
There are many women for whom HRT is C/I.
It’s just noise and again denigrates our role

Simon Gilbert 12 October, 2022 5:44 pm

No pressure groups ever ever ever mention the prescription prepayment scheme – max c£10/month for all you can eat NHS medications!

David Church 12 October, 2022 7:09 pm

“MPs should wake up and realise we are in the middle of a Pandemic, and NHS staffing crisis, capacity crisis, prices crises, fuel instability, financial instability and an avoidable NATO-caused, WAR, and they should be made to DO something about all these themselves before telling GPs what we ought to be doing, or at least fund their demands properly.

David Church 12 October, 2022 7:11 pm

If enough of us (ie 2 or more) agree, the headline tomorrow could be “GPs tell MPs how to do their job properly”

Patrufini Duffy 12 October, 2022 10:25 pm

Good point Simon. They’ve got “specialised” nurses and Harley Street gynaecologists churning out the propaganda. Sign the HRT disclaimer. One gynaecologist on her last slide said, “If all else fails, change your husband”. Not funny, change your mirror perhaps. Soon there will be more women rubbing up testosterone than men, and more irregular bleeds than a 2ww can handle.

Patrufini Duffy 12 October, 2022 10:37 pm

Here’s the menopause health check: “You’re going to go through the menopause”.

Apparently men are getting all the attention in the NHS, that old chestnut misnomer, and all the ultrasounds, tired all the time panels and early cancer diagnoses. They’re getting all the limelight, and media attention on posters and recalls. They’ve know contracted panic attacks sadly from the water works. They are swamping urology, apparently, having exponential PSA Tests, countless internal examinations and recall, and are laced in nannying with regular blood pressures, hugs, pill checks and mandated access for that for at least 10 years of their life. Apparently. No health check for “them” / “it’s” / “who knows what’s” at 45. To deal with supporting the menopausal? Contentious. Perhaps NHSE will name it a carers consult, or something inclusively stupid like that. Double whammy. Plenty of capacity.

Keith M Laycock 13 October, 2022 6:19 am

As anyone devised a LFT (Lateral Flow Test) to measure LH & FSH – if not, there’s fortune to be made. Who needs a Doc (or Nurse, Pharmacist, Uncle Tom Cobley an’ All etc) for the diagnosis.

Then just order the HRT on-line – Amazon, free delivery over …..

David Banner 13 October, 2022 10:26 am

1980s-“Individualise risk/benefit of HRT”
1990s- “Give HRT to everybody !”
(Million women study published)
2000s- “Give HRT to nobody!”
2010s- “Individualise risk/benefit of HRT”
(Pressure groups badger MPs on dinosaur GPs)
2020s- “Give HRT to everybody!!” (Daily Mail circa 2030-“Spike in breast cancer, stroke and DVT in women blamed on incompetent GPs’ indiscriminate prescribing of HRT to inappropriate patients”)
2030s-“Give HRT to nobody!”
2040s-“Individualise risk/benefit of HRT”

Nicola Williams 13 October, 2022 4:12 pm

At a time when GPs are drowning or retiring why add more political correctness madness into the pot? Davina Mccall has spread the word and women are coming in in droves . What would we be checking for anyway ?. It happens to ALL women , Some want treatment , Others do not. And i speak as one of those peri-menopausal women , and although it is bad, there are far worse conditions out there we could be dealing with .