What does a Menopause Health Check look like?
Because of the drop in oestrogen hormone levels that occurs throughout the menopause, women over the age of 50 are much more likely to develop high blood pressure, diabetes, obesity, high cholesterol, have a heart attack or stroke and one in three will have an osteoporotic fracture.
All of these conditions are preventable.
A Menopause Health Check or, as I like to call it: ‘You are Fab and 50 Health Check’, needs to be a holistic, patient-centred health check, looking to prevent conditions like high blood pressure, diabetes, heart disease and osteoporosis.
High Blood Pressure
Up to one in three women over 50 have hypertension or high blood pressure and most are unaware because they do not come to have it checked. The problem with high blood pressure is you feel absolutely fine up to the moment you have your heart attack, stroke, or your kidneys fail. This Health Check is an opportunity to pick up hypertension before it does any damage. Review of a woman’s personal, as well as family history, will tell if she is high risk for developing hypertension, heart disease and stroke.
Diabetes
If there is a family history of diabetes or a woman’s BMI is over 30, we do a blood test that will pick up pre-diabetes. Advice about lifestyle and diet changes empowers that woman to actually avoid developing diabetes.
Heart Attack and Stroke
We use the Q3Risk assessment tool that tells us how high a woman’s risk is of having a heart attack or stroke in the next 10 years, which guides advice on whether a statin medication should be started in order to reduce that risk by up to 50 per cent. www.qrisk.org
Osteoporotic fractures
We have an osteoporosis risk assessment tool, FRAX, that tells us if a woman is at high risk of osteoporotic fracture and might benefit from an early DEXA scan. www.frax.shef.ac.uk
We advise on regular exercise in combination with weight bearing exercise with calcium and vitamin D supplements to prevent osteoporosis. Smoking cessation advice is vital as this impacts risk of heart attack stroke as well as osteoporosis.
A Menopause Health Check is about disease prevention and supporting women to live long and healthy lives. At Bantry Bay Medical Centre, we have started inviting patients in for a 50-plus Health Check.
Have you noticed that so far, I have not even mentioned HRT?
So, what is your government doing to get you access to a Menopause Health Check?
Yes, it is admirable that this government has generated The Women’s Health Action Plan 2024-25 (gov.ie). It means that your government is actually thinking about Women’s Health Service provision.
The document mentions HSE-funded Menopause Clinics in secondary care, eight across the Republic. This is good. However, as a GP working in West Cork, I know these are not bread and butter menopause services. They are intended for patients that GPs do not feel confident in managing, as is the case for The Complex Menopause Clinic in CUMH, and referral criteria are very strict.
I naively assumed The Women’s Health Action Plan might contain details of funding going into Primary Care so that high quality Menopause Health Checks can be delivered; that is not the case.
The expectation is that a woman goes to her GP for her Menopause Health Check and treatment. I completely agree; GPs in Ireland are more than qualified to do this.
That’s not the point.
So, Mr Stephen Donnelly, Health Minister; you are promising free HRT medications for all?
HRT is only a small part of a Menopause Health Check. Promising to fund HRT medications without funding the consultation is an insult both to women and to their GPs.
The fact that this is suggested as a fix for current poor access to high quality Menopause Consultations for women across Ireland means, Stephen, that you haven’t a clue.
Government needs to start listening to what women, as well as their GPs in Ireland, have to say:
My 50-plus female patient wants enough time in her GP appointment to discuss all aspects of her health, disease prevention as mentioned above, as well as her many and myriad menopause symptoms. The appointment needs to allow time for necessary intimate examinations and; subsequent discussion on what management plan suits her best.
GPs know that a minimum 30-minute appointment is needed for the type of quality Menopause Health Check I describe.
I have emailed Stephen Donnelly’s office in the Oireachtas on this very point and just received a reply to the effect that the free HRT medications that is planned will solve everything.
It made me so angry.
It is an insult to the women of Ireland to suggest that something as complex, personal and sensitive as Menopause can be adequately dealt with in a 10- to 15-minute routine GP appointment in the same way as a cough, sore throat or back pain.
So what would work?
If the funding was there, GPs would be able to set up a dedicated Women’s Health Clinic with the required 30-minute appointments, as we have done in Bantry Bay Medical Centre.
There is a funding system in place for Women’s Health checks for women of childbearing age, the Free Contraception Scheme. Many GP lists are closed because of work pressure so women who don’t have a female GP cannot get in to see a female doctor. Most of the women I have seen over the last year would not dream of going to discuss their menopause, vaginal or incontinence issues with a male GP.
The Free Contraception Scheme allows for a patient to see a GP that is not her usual doctor for contraception consultation or a coil fitting. This is a fair system that recognises that not all GPs are contraception specialists, as I am.
The same needs to be acknowledged when it comes to Menopause consultations; not all GPs feel confident, or indeed have the time to have those conversations, undertake required intimate examinations, investigations, then generate the management plan that is right for that patient.
HRT is only a small part of a Menopause Health Check. Promising to fund HRT medications without funding a Menopause Consultation is an insult both to women and to their GPs.
I would go further and say that it is downright ageist that HSE does not fund a Health Check for women in their post-reproductive years in the same way they do for women of childbearing age.
westcorkmenopauseclinic.ie
