Dr Sarah Gray
GP Specialist in Women’s Health
Dr Paula Briggs
Consultant in Sexual & Reproductive Health, Liverpool Womens NHS Foundation Trust
The impact of the media debate around the Women’s Health Initiative (WHI) study in 2002 is still being felt today as women and GPs lack confidence in HRT, despite newer studies confirming its effectiveness.
For Dr Paula Briggs, previously a GP and now a Consultant in Sexual and Reproductive Health in Liverpool, many issues with prescribing menopause care can still be attributed to the WHI study. These attitudes impact on what gets ordered and prescribed in each region.
Challenges in accessing treatment
She says, “In our area we’re lucky to have a very forward-thinking Deputy Chief Pharmacist who cares about menopausal options, but I have patients visit from a neighbouring trust who are desperate for information and products that aren’t available just a few miles down the road.”
“This is in part due to the sheer size of the multi-disciplinary teams that prioritise hospital care, if there are no menopause advocates on board then it’s hard to fix the restrictive behaviour in area prescribing committees.”
Dr Sarah Gray, a GP in Cornwall for 30-years with a specialism in women’s health, believes that it was the negative messages stemming from both the WHI and the MWS which were so damaging. They contributed to funding for her specialist menopasue clinic being cut.
The council will pay for a coil fitting for contraception reasons, but not menopause. And if the Clinical Commissioning Group (CCG) says no – then who pays?Dr Sarah Gray
While attitudes are now beginning to change, Dr Gray already feels that valuable time has been lost and that there have been little updates through the NHS on HRT. She says, “For a long time it seemed as though the profession was hesitant around HRT as when the messaging surrounding the study came out, it created a negative discussion in the media. Luckily over the last few years that has started to change. However, there are still significant gaps in some GP’s knowledge. Many recognise this and because of the problems experienced by their patients are thinking ‘I need to know this’ which is why education for both GPs and patients is so important.”
Tackling funding issues
But both women believe that the innovation between collaborating colleagues is what will drive the conversation forward on the benefits of menopausal care, such as a reduced risk of osteoporosis.
The problem at the heart of these issues is funding. Dr Gray adds, “The council will pay for a coil fitting for contraception reasons, but not menopause. And if the Clinical Commissioning Group (CCG) says no – then who pays?”
For Dr Briggs, she believes the issue is bigger than a North/South divide, she adds, “There would not necessarily be a menopause expert on the Area Prescribing Committee when a decision is made whether to add a drug to the formulary. Local experience of a drug is required to inform the Committee prior to consideration to add a particular product to the local formulary, making it available for GP’s in the area to prescribe on the NHS.”
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