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HRTeetering on the brink

HRTeetering on the brink

Columnist Dr Copperfield questions whether a ‘menopause check’ is clinically appropriate and effective

Flushing hell! Look, I realise I’ll probably get slaughtered by at least half the population for saying this. And so, for the avoidance of doubt, I want to make it absolutely clear: no, I’m not a misogynist; yes, I do believe the menopause exists; no, I’m not anti-HRT; and yes, I feel almost as euphoric as my menopausal patients when the oestrogens I’ve managed to prise from the pharmacy kick in.

But FFS. We’ve tolerated a fairly lengthy period of ‘raising awareness’ of the menopause and all its implications, this raising awareness occurring at a time when we seemed to be talking, and hearing, about little else, and therefore wondering what awareness there was left to raise.

Yet, a couple of weeks ago, we had the All Party Parliamentary Group on Menopause suggest that menopause ‘discussion’ should be incorporated into health checks and incentivised within QOF. And now we have a health minister neatly demonstrating how politicised, unscientific and pre-determined the ‘debate’ has become by, on the one hand, saying the DHSC has asked the NHS health check advisory group to ‘review the case’ for including the menopause, and on the other stating it is ‘crucial’ that menopause is incorporated into the health check. So that’s the review done, then.

Reminder: I know the menopause exists, it can be bad and it can be treated. But I really resent unscientific drum-banging smothering perspective and rationality. Even if we accept that health checks are worthwhile at all – and that isn’t a given – where is the evidence that a ‘menopause check’ (whatever that is) is clinically appropriate and effective?

And why should GP action and payment through QOF dance to the tune of a single issue pressure group? If them, why not patients suffering arthritis, or Parkinson’s, or LUTs, or sinusitis, or Peyronie’s, or Plummer-Vinson-Patterson-Kelly-Brown syndrome, or work-related stress caused by mob behaviour dictating educational needs and terms of employment?

Because, with general practice, the clue’s in the title: generalism. We deal with everything and have that perspective that tells us that any one illness is pretty much as important as any other, especially to the individual suffering it. As soon as one assumes priority, it distorts everything and undermines the genuine entitlement of others.

Plus, there comes a point where raising awareness becomes alienation of the very group you’re trying to onboard, and that point is now. In better news, I hear that HRT shortages are over. So can we move on?

Dr Copperfield is a GP in Essex. Read more of his blogs here



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

Truth Finder 3 November, 2023 3:50 pm

Could not have said it better. Brilliant! This is what happens when people with little knowledge and being unscientific tries to bully professionals into doing unscientific poorly evidenced things.

Simon Gilbert 3 November, 2023 5:33 pm

Policy being dictated by pressure groups and politicians is not a bug of a sole government pay health service with no top up or transferable vouchers. It is the core feature.

The government is the customer. Therefore the game is for everyone to influence the government to ensure one’s favoured diagnosis gets more resources. There is no other outcome under this model.

Stephen Aras 3 November, 2023 5:37 pm

I do hope you are not questioning St Davina of the Hot Flush?!

HRT is as we are told is a universal panacea for at least half the population over 50.

As one of our Lords and Masters said – “Who needs experts?” – Thank you (soon to be Lord Govey of Twatsville.

Joe McEvoy 3 November, 2023 5:52 pm

My understanding of the current situation is that any woman who requests HRT and has no contraindications should be prescribed it- regardless of menstrual state and hormone levels as it could be perimenopause.
And 40 is the new 50 for this!

If I hear the phrase ‘Brain Fog’ one more time I’ll take a hot flush

Some Bloke 3 November, 2023 6:29 pm

Loved the article and the comments above.

Nicholas Sharvill 3 November, 2023 8:12 pm

There is money in HRT, lots of it. We know from the bmj that lots of patient pressure groups receive funds from pharmaceutical firms and those pressure groups contact ministers who also like to be on the side of celebrities.
But if fsh and oestrogen levels are normal, a cycle is normal and no hot flushes is it ethical to prescribe HR T at age 40…..

Marie Williams 3 November, 2023 8:40 pm

Agree entirely Mr C ( in between hot flushes).
I am endlessly riled by the fact that those in the media who shout loudest about their vested interest illness/condition get the most attention making some conditions more important to NHSE than others.
Wrt to understanding the menopause and the blight on women’s lives it can cause …..well its about time !
However, the cynic in me often yearns for a high profile person to get a disease /condition preventable by immunisation or screening as a backlash against the nay-sayers and social media conspiracists, to benefit the health of our population as a whole…….. Does that make me a bad person?

Shaba Nabi 4 November, 2023 7:49 am

Well said

And I say that as a menopause specialist and a post menopausal woman!

David Church 4 November, 2023 8:23 am

Let’s see : The perimenopause lasts an unpredictable amount of time, possibly with a huge variety of symptoms, yet there is no good test available on NHS.
I can provide results on blood samples sent to me with £100 in used (but clean, please) banknotes and a brief patiet history, that confirm that perimenopause is present, with a rider that that does not exclude other potential serious diagnoses, as a private service.
Should I start seeking promotional partnerships for this service in high street pharmacies?

Nicola Williams 6 November, 2023 1:37 pm

speaking as a menopausal woman- well said Dr Copperfield

David Jarvis 9 November, 2023 1:52 pm

But now anastrozole as a breast cancer preventative. Wait does that mean oestrogen presence has an effect on breast cancer risk then???

Sam Macphie 17 November, 2023 5:19 pm

Don’t you mean to be precise, “Can’t we move on – until the next flushing shortage of HRT?” Haha.
Supplies can be a bit unpredictable for GPs to work around: a bit like some flushes we suppose.