An excellent discussion. Lots of areas where there was learning and confirmation of practice. There was also discussion about our role as patient advocate in 2 of the cases. Should we stop the HRT in the 74 yr old lady suddenly? What about if it was contra-indicated. Also the role of alternative medicine – if we advise it as an option & the patient is harmed, where do we stand?
Unaswered questions were:
- Circulate a Menopause Rating Scale (ASW to do)
- Should we ask opportunistcally about peri-menopausal symptoms?
- When using topical E3 gel as a systemic therapy (as opposed to vaginal gel), what are the options for providing progesterone? The IUS was discussed as an excellent option but what about if it was contra-indicated or if the patient declined? Are progesterones actually required if use of E3 gel is intermittent and on a PRN basis? (JCS to find out).
- Which is the best primary care tool for memory/dementia screening (TW to find out).
- What are the absolute contra-indications for HRT and smoking? (ASW will investigate).
Two new members (both young males) expressed concern about the limitations of their knowledge in this area. Whilst we all expressed this (we do not have many patients with peri-menopausal symptoms), it is something that needs to be raised on the PQO/PGMO course. The curriculum should cover common urogenital problems in middle aged women at least so GDMOs are confident in raising the subject. Women are known not to volunteer conditions such as loss of libido and stress incontinence.
Areas of learning we discussed:
- The use of a topical E3 gel as a systemic therapy.
- Use of self help web sites – Amarant Menopause Trust.
- One of the scenarios involved a concern about dementia. We moved on to scoring systems in primary care – 6 question CIT, MMS.
- We all agreed the time constraints in a single consultation would rule out a comprehensive history, examination and investigation. Another option was to spread over 2-3 consults with the patient doing some research in the interim.
There shouldn’t be too many barriers to change. ASW will raise the issue of the curriculum change with the GP Dean next week on the Tri-Service Trainers Course.
Most of what we discussed had mutual agreement. Some guidelines were discussed and we agreed that a single sheet of pros/cons of the long term risks & benefits might be a useful tool in the surgery.