Access to the right treatment

All of us who need medical treatment in menopause and perimenopause ought to be able to rely on access to that treatment. Sadly that doesn’t always happen, but things are improving.

This week the British Menopause Society in collaboration with several other specialist bodies, released an important document — New Menopause Practice Standards. These are guidelines for doctors, and an important resource for us when advocating for ourselves with our doctors. You can find a link to download the document in the link above.

Who Needs It?

Not everyone of us will need medical treatment. Around 20% of us get through perimenopause and menopause with very few symptoms. I’ve talked to women who have woken up one morning realised that they hadn’t had a period for ages, and that was just about it.

If that’s you, congratulations! If, however, your menopause has happened early you should still have a conversation with your doctor about whether HRT would protect your bones and possibly your brain.

What are the options?

Hormone Replacement Therapy is now generally considered to be the first choice of medication for menopausal and perimenopausal symptoms. The risks are now known to be much lower than previously thought — and patches, gels and sprays that are absorbed through the skin are generally thought to be suitable even if you have high blood pressure or a risk of clots.

For some women testosterone might be appropriate. Currently the evidence that it helps with anything other than sexual desire is not great. But some women do find it helps with other symptoms. It might be worth a shot — it might not be something your GP will prescribe — which might mean you need to see a menopause specialist and possibly a private one. Equally, sometimes, it’s not the solution that someone hopes it will be.

But there are non-hormonal options. They include medications like gabapentin and clodonine, and there is a new drug in development specifically for hot flushes. Some anti-depressants may also be useful. I can’t tell you which drugs you should be taking — that’s a conversation with your doctor. If you do need to find out more about any of those medical options, I’d recommend having a look at the Women’s Health Concern’s excellent factsheets.

There's also a new non-hormonal drug treatment called Fezolinetant already approved in the USA and currently going through the approval process with NICE and a second one on its way.

Specific symptoms might also benefit from medical support. Your doctor can help with bladder issues, with vaginal and vulval probems, (and personally I would very much recommend vaginal oestrogen to help with these issues) with menstrual issues, with allergies and inflammation, joint pain and many more of the strange symptoms that crop up in perimenopause. It’s possible to find ways of dealing with those symptoms whether or not you chose HRT.

What can schools do to help?

Schools can play an important role in menopause education. By providing your staff with information and insights into menopause and perimenopause you give them an opportunity to ‘join the dots’ and realise that all their strange symptoms are menopause related which enables them to make the right choices.

Schools can also signpost staff to further sources of information — and they can host workshops and support groups that help staff in making crucial decisions about their medical options.

They also need to make sure that staff can attend medical appointment as quickly as possible. That’s especially important right now when medical appointments are hard to get. It can take several appointments to find the right solution, especially if there’s a need for investigations.

A lot of teachers are tempted to put off doctor’s appointments until school holidays. That can mean it takes many months before a problem is solved and a teacher is back to firing on all cylinders in the classroom.

It’s important to say that medical treatment is only one of the elements of living a healthy menopause. It’s not a case of ‘take your HRT and shut up and get on with it’. We may also need to take other kinds of action — and we may also need adjustments to be made to our working environment alongside medical treatment.

But more about those other six pillars of a healthy menopause soon!