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Author Topic: NICE guideline on menopause  (Read 43289 times)

Meg

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Re: NICE guideline on menopause
« Reply #15 on: April 24, 2013, 12:10:43 AM »

Thank you Doctor Currie.  I really hope that doctors could be better informed and more sympathetic. If they came to forums like this they would learn a thing or two.  Some women seem to be more knowlegable than some of them.  Nausea was something my doctor had never heard of in connection with menopause and I am with all of the other ladies on the fear/anxiety issue, there should be more help available and sadly not everyone can take HRT or even gets on with it but there should be more education about how it can be prescribed and possible alternatives.  Menopause is a massive issue, it comes to all women and can have a huge impact on their lives and the lives of their nearest etc.  I hope NICE is sympathetic because I associate NICE with budget cuts and sometimes we need prescription medication alongside other measures.  At present many women are not getting the help they are crying out for.  Good Luck.

Meg
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Soupdragon

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Re: NICE guideline on menopause
« Reply #16 on: April 27, 2013, 05:44:17 PM »

Automatic referral to a knowledgable, qualified specialist for anyone who finds their GP isn't able to give adequate treatment - it astonishes me how many of the members here on this site are being poorly served by their GPs.
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Soupdragon

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Re: NICE guideline on menopause
« Reply #17 on: April 27, 2013, 05:48:03 PM »

i hope the guidelines will cover surgical menopause and also early as i was 40 and mine due to surgery.  without seeing a private gynae i would not have got vagifem nor been able to get enough oestrogel for  month.  gps even those who claim to have attended your seminars are very out of touch.

I would like to echo this.  I've just gone through surgical menopause and quite frankly my GP is clueless.  I'm having to go private to obtain topical oestrogen for VA as my GP thinks it could get better on its own.  So many women seem to be let down by the very people who should be helping them.

These examples make my blood boil!! Seriously, these GPs need remedial CPD!!
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Dr. Heather Currie

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Re: NICE guideline on menopause
« Reply #18 on: June 02, 2013, 12:13:56 PM »

As you may know from this thread, new national guidelines for diagnosis and management of menopause are being developed by the National Institute for Clinical Excellence (NICE). This will be a really significant development in women's health care.


NICE is now inviting comments on the draft scope, which sets out what the guidelines will cover http://guidance.nice.org.uk/CG/Wave0/639/ScopeConsultation. We will be responding to the guidelines as part of a network called Menopause UK and will publish our response at the end of June. Do leave comments and suggestions for us here.  Our view is that the draft scope is a comprehensive and sympathetic document. We are especially pleased that it recognises the needs of women in early and or surgical menopause. We have some questions about the way the guidelines will address the needs of women who have had breast cancer or who are at higher risk of breast cancer, which we will raise as part of our response.   


NICE are also recruiting members of the guideline development group. Do take this opportunity to encourage people you think should apply. The positions being advertised are: Consultant gynaecologists; Community gynaecologist; Specialist menopause nurse; GPs; Practice nurse/nurse practitioner; Physician (with a special interest in cardiovascular health);  Physician (with a special interest in bone health); Lay members. The closing date for applications is 21 June 2013. The full advert for the positions can be found here http://www.nice.org.uk/getinvolved/joinnwc/MemberDiagnosisManagementMenopauseGDG.jsp and the lay members link is here
http://www.nice.org.uk/getinvolved/joinnwc/LayMemberDiagnosisManagementMenopauseGDG.jsp
 
We are founding members of a network called Menopause UK which is making sure that the guidelines benefit from being informed by the knowledge and insights of women affected by menopause. Other members of the Menopause UK network include: the Daisy Network, the Hysterectomy Association, and two social networking forums, Post-Op Hysterectomy for PMS/PMDD and Early Menopause UK Active].   

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Hurdity

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Re: NICE guideline on menopause
« Reply #19 on: June 20, 2013, 08:46:07 AM »

Hi Dr Currie

It's fantastic that new NICE guidelines are being developed to give GPs up to date information on which to base treatment of women during and after menopause.

Some of what I want to say has already been said earlier in the threads but you asked for comments in relation to the draft scope so these are just some thoughts on the whole issue generally - sorry it's a bit late and also long!

I had a look at the draft scope and I wondered how far the review will recommend areas for future research and also what the relationship is between guideline development and drug companies?

The document says that recommendations will mainly base the review on licensed products and methods but only exceptionally otherwise, if supported by evidence.

Personally I feel that this is a very important area – and especially in relation to unequal treatment of women. Currently those women living in geographical areas where leading (research and practising) gynaecologists practise on the NHS, are able to access their (gynae) expertise and due to their knowledge are able to receive individualised treatment in a way that they cannot from most GPs. Similarly, those who can afford to do so, go to private gynaecologists at considerable cost for similar treatment and prescription. Also many areas are not served by NHS menopause clinics.

I would hope that the new guidelines would do something to try to lessen this inequality so that all women have access to the best possible treatment and with the latest knowledge and research.

In order to do this there are still a lot of areas where research is needed to provide the evidence on which to base treatments.

Topics that are discussed frequently on this forum include: long cycle HRT (other than Tridestra - the single proprietary brand currently available) – ie longer than monthly, and long term use of HRT particularly in the over 60's – with many still being asked to stop at 60 or before. I note the guidelines only refer to looking at the effectiveness of HRT and other treatments in the short term (5 years) but some of these can also be present long term eg urogenital symptoms and others. Many of us would like to stay on HRT for life if possible and this is an area where up to date studies and research are needed, and especially using what is thought to be lower risk transdermal bio-identical estradiol and progesterone.

A major area needing research and licensing in UK is evidence and dosing for using other forms of progesterone currently available in other countries or off licence here ie Cyclogest, Crinone gel and vaginal use of Utrogestan.

Other areas which seem to need more research are : long term vaginal use of local oestrogen; if possible a bit more precision in the dose of progestogen to oppose specific doses of oestrogen especially micronized progesterone, in preventing hyperplasia (at the moment often standard amounts are prescribed by GPs irrespective of oestrogen dose).

An area many of us know very little about but which urgently needs more research and proper treatment with hormones if necessary is reduced libido and treatment with appropriate women specific formulations of testosterone and the availability of testing and treatment for this on NHS rather than mainly privately as now.

I don't know how the drug companies relate to the Dept of Health but will it be possible to commission or recommend additional products eg re-introducing Vagifem 25 mcg for those for whom 10 mcg is not effective? The studies on which this was based were very small and as always based on a percentage of women and statistical significance – so what about the rest ie the percentage of women for whom that dose is ineffective?

For progesterone intolerant women – the need to re-introduce dydrogesterone as a separate product to enable better adjustment of dose in relation to bleeding  – currently only available as combined tablet.

The need also to produce greater variety in dosage of progesterone eg lower strength vaginal gel,  half strength micronized progesterone to enable splitting the dose daily ( eg 2 x 50 mg) and also to enable reduced dose for those on very low dose oestrogen (patches or gel).

These are just my thoughts as a menopausal woman based on my limited knowledge and experience – as I don't know what guides research and how the drug companies work.

Many thanks for consulting us and we look forward to hearing more in due course

Hurdity x




« Last Edit: June 20, 2013, 11:33:01 AM by Hurdity »
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ancient runner

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Re: NICE guideline on menopause
« Reply #20 on: June 20, 2013, 10:47:09 AM »

Hurdity, it strikes me that you should be encouraged to apply for a lay member's post on this commission mentioned in Dr C's last comment. Please do!
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Dandelion

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Sorry to resurrect this thread
« Reply #21 on: May 04, 2014, 07:41:29 PM »

I read this thread with enthusiasm and hope, yet I cannot find treatment guidelines on NICE.org.uk.
Am I missing something? Looking in the wrong place?

Thanks
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Dancinggirl

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Re: NICE guideline on menopause
« Reply #22 on: May 04, 2014, 09:26:17 PM »

Hi Dandelion
I think this consultation process is still in progress - so no new NICE guidelines yet.
We all live in hope the results will be positive.
I think Hurdity and many of the others on this thread have brought up some very important points.
My view is there needs to be some major training of GPs to help the ever growing number of women reaching meno.
I'm sure this site will be one of the first places to see the new guidelines when they come out.
DG x
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jgr

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Re: NICE guideline on menopause
« Reply #23 on: May 05, 2014, 04:28:18 PM »

I have found that the GP's don't really know enough about menopause symptoms. Anytime i went to them with unexplained symptoms (thought i had some deadly disease) they almost rolled their eyes as if i was some kind of hypocondriac. One Dr eventually told me about this site and the rest is history. Once i was referred to the meno clinic, it all fell into place. The other problem i have found is that my surgery have not called me back at regular intervals to see if i still need the HRT, my understanding is you should be checked approx every 6 months and this has not happened. Considering every woman has to go through this horrid time, all i knew of meno symptoms was hot flushes. If we are told more about what we may experience, it would prevent a lot of women suffering needlessly.
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Hurdity

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Re: NICE guideline on menopause
« Reply #24 on: May 05, 2014, 07:53:08 PM »

Yes Dandelion you should need a review - but you will have to make the appointment. My prescription tells me when my review is due so I phone up and book a consultation with GP.

Re NICE guidelines. 2015 is the intended date - the development group is meeting regularly to reviw the literature, discuss with experts and come up with recommendations. I imagine there may also be a consultation process when the draft guidelines are produced too, and if so, Dr Currie will update us and ask for our opinion as she has done at the different stages in the process.

Hurdity x
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portese

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Re: NICE guideline on menopause
« Reply #25 on: June 10, 2014, 02:52:47 PM »

More advice about treatment of older women -I am 76--who want to stay on HRT.   Are the risks dose related and have there been any studies and conclusions in this age group. Having trie to come off many times and at last all is calm on Premarin one only three times a week, I have a special interest in this topic. 
Very many thanks for your wonderful support.
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Kelly

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Re: NICE guideline on menopause
« Reply #26 on: July 06, 2014, 07:32:11 PM »

Yes brilliant support Here  and emailing Dr Currie was my lfe line, Unfortunately my doctors practice simply direct everyone to menopause matters website and I seriously doubt they have ever looked at it. My female doc said anxiety in menopause was rubbish and that ladies of a certain age get GERD because they enter the menopause overweight!!
I call for a menopause doctor/ nurse in all health centres and all the symtoms to be widely known.


Kellyx
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cheekygal

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Re: NICE guideline on menopause
« Reply #27 on: August 01, 2014, 09:37:55 PM »

I agree Kelly, there should be more NHS menopause clinics or like you say trained staff in health centres, GP practices.  There is a private one where I live, but that's not an option for me I'm afraid.
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kiltgirl

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Re: NICE guideline on menopause
« Reply #28 on: August 02, 2014, 04:43:08 PM »

Would like to see GPs not write women off for help with peri or meno symptoms just because they are not the 'average' age for treatment. I started having peri symptoms about 4-5 years ago, of course I was 41 then and couldn't possibly be in need of any help. I asked for a printout of my bloods and my FSH was high and estradiol was low...but doc said it was fine!!?? and that I just needed to sort out my lifestyle (!!??)
too many times leaving the surgery in tears...

and my ex MIL is in her 60s, desperately wants to get back on HRT, she is a vibrant amazing woman who feels like death but they won't help her.
Maybe the guidelines or whatever they use to determine who gets help need to be adjusted. Women are living longer...and for whatever reasons we are also entering meno earlier.

just my tuppence worth x
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Kelly

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Re: NICE guideline on menopause
« Reply #29 on: August 04, 2014, 12:14:48 PM »

I just despair of doctors nowadays ! I had one hold open the door saying it was only a ten minute appointment while I sat crying in the chair!! They need to be a lot more aware of menopause symptons not just hot flushes!
Kellyxx
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