A pioneering nurse-led scheme is offering employees of a health board in Wales access to specialist menopause clinics, as Nikki Noble explains.
Peri- and post-menopausal women make up a significant proportion of employed women in the UK. There are over 4.3 million employed women aged between 45 and 60 in the UK. In the NHS more than 77% of the workforce is female with 47% of very senior manager roles are held by women.
The problems experienced by women in the workplace include poor concentration and memory, tiredness, low mood and decreased confidence. A British Menopause Society survey carried out in 2016 of women aged 45-65 revealed more than a third said the menopause affected their work life. A fifth (20%) experienced difficulty with memory and concentration and 42% felt their menopause symptoms were worse or much worse than they expected.
About the author
Nikki Noble is lead nurse, menopause and safeguarding, within the Directorate of Sexual and Reproductive Health at Aneurin Bevan University Health Board
In my role as an advanced nurse practitioner in menopause I became more aware of the difficulties women were experiencing in work. This included a lack of information about menopause and how to manage their symptoms. I also noticed a number of referrals to our specialist menopause clinic were for staff of the health board.
I set out with the aiming of improving the welling of staff employed by the health board in relation to menopause, their symptoms and the impact on their work.
Aneurin Bevan University Health Board – the health board I work in – employs over 13,000 staff and covers a wide geographical area including the boroughs of Blaenau Gwent, Caerphilly, Monmouthshire, Newport, Torfaen and South Powys.
There are two district general hospitals, two local general hospitals, 11 community and mental health hospitals and day care premises as well as multiple community clinics.
Before setting up clinics I decided to start by offering menopause awareness sessions to staff, these are open all staff of the health board, whether they want to learn about menopause for themselves or to gain more knowledge to support patients, colleagues or staff they manage.
The sessions are held throughout the health board, covering a wide area to allow attendance without staff having to travel too far. The sessions consist of a 20-30 minute presentation, which is informal and is followed by questions and discussion. Feedback is always obtained and the sessions are adjusted and improved as per the responses.
The sessions are always well-received and some example of feedback include:
- “Information was helpful and sufficient time was given to cover everything”
- “Really enjoyed it, it’s good to talk!”
- “Very relaxed and good interaction from group”
Once the sessions were established, I began to be contacted by various departments throughout the health board to attend their place of work to speak to groups of staff. Sometimes these are arranged by the managers of these areas to support staff or by a member of staff themselves.
These sessions are always well-received as the colleagues interact well and they can often be a lot of fun as women talk about the issues they’ve experienced both at home and in work.
These sessions are now ongoing as a rolling programme covering as many areas of the health board a possible and I also visit specific areas when requested – often it’s a lunch time meeting at the end of multi-disciplinary team meeting when staff are already gathered.
Self-referral staff menopause clinics
Again once the awareness sessions were up and running and established, I started looking at setting up a nurse-led menopause service for staff.
It was a challenge to find a space where it would be appropriate to see staff and which would be available at the times needed. In a local general hospital I am able to use the occupational health facilities; it is a new-build hospital and it is helpful for staff as they are already familiar with the location.
But the other two clinics are held in the district general hospitals, in the north and south of the health board, in the sexual health clinics, as this is the directorate I work in. Staff are often not familiar with the location of the clinics, so the booking staff always ensure that directions are given if staff attend these clinics.
Initially I considered allowing the clinics to be “drop-in” but I felt appointed clinics would be easier to manage as the workload would be known in advance.
The clinics are self-referral and all staff have to do is telephone the booking number where a member of the admin team with take their demographic detail and ask them which clinic they would prefer to attend.
When a staff member attends the clinic they have their blood pressure, height, weight and body mass index checked and recorded. They then have a full medical, drug, family and social history taken. They also have a gynaecology history taken and are asked about contraception and when their last menstrual period was.
They are then asked about symptoms and these are documented. This is very useful, as the symptoms can be referred back to when a patient returns for their follow-up appointment to see which have changed or improved.
Menopause in general is discussed along with treatment options. Often the staff have already been to an awareness session so they know about lifestyle measures and the prescribable treatments available to them.
The majority of women will opt to try HRT – it is a prescribing service so I will then prescribe the HRT after discussing which options (in other words a patch, gel or tablets) they would prefer dependent upon their BMI and medical/family history.
I then prescribe a three months’ supply of treatment. I then send a summary of the consultation to the patient with a copy to their GP so they are aware of the consultation and the treatment started.
Review after three months
In line with NICE guidelines I then review them after three months. If they are happy with the treatment then I will discharge them to their GP and write to the GP so they are aware. Some patients prefer to come back to the clinic for their yearly review, so this is arranged. Staff also know they can contact me by email if needed.
I have recently surveyed the staff that have attended the clinics (anonymously) to get an overview of why they attended the clinic rather than their GP, how work had been affected and any improvements that could be made as well as any positive features.
The main reasons identified for attending the staff clinics were that the GP was not understanding and there was time to talk about issues. Some of the quotes taken from the questionnaires are below:
- “Excellent service”
- “I found just talking about the menopause was extremely beneficial”
- “Knowing my next appointment is in a few months makes me feel better”
Points for occupational health nurses
Reassurance and signposting are really important when seeing women with menopausal symptoms in the occupational health setting. They should be reassured that the symptoms are normal and attributable to menopause. There are many useful websites available to signpost them to and these are listed at the end the article.
Lifestyle adjustments should be discussed as for omen with mild symptoms these may be enough to manage the symptoms they have. The following gives examples of lifestyle changes and the reasons for them.
- Lifestyle change: Stop/reduce smoking
- Rationale for doing so: Women who smoke more likely to have hot flushes
- Lifestyle change: Reduce weight/maintain health body weight
- Rationale for doing so: Women with a BMI over 30 more likely to have hot flushes
- Lifestyle change: Improve diet (five a day fruit and veg, good calcium intake)
- Rationale for doing so: Overall health benefits, calcium maintains bone health
- Lifestyle change: More exercise
- Rationale for doing so: Exercise helps maintain/reduce body weight, improves memory and concentration and reduces anxiety
- Lifestyle change: Be aware of triggers for flushes, for example spicy foods, alcohol
- Rationale for doing so: Will reduce amount of flushes
The occupational health nurse should be aware of any policies in their workplace that refer to menopause. For example, the NHS in Wales has an All Wales Menopause Policy for staff employed in the health boards.
I am aiming to establish sessions that are specific to line managers, again general menopause awareness but with advice on how to support staff who need help within the workplace to manage their symptoms.
I am also planning to undertake training in cognitive behavioural therapy to be able to offer sessions to staff to support them in self-management symptoms – in particular hot flushes and night sweats.
Guidance specific to menopause and occupational Health
- Guidance on menopause and the workplace (Faculty of Occupational Medicine) www.som.org.uk/sites/som.org.uk/files/Guidance-on-menopause-and-the-workplace.pdf
- Let’s talk menopause (Chartered Institute of Personnel and Development) www.cipd.co.uk/Images/menopause-leaflet_tcm18-55569.pdf
Useful websites for nurses
- The British Menopause Society – www.thebms.org.uk
- NICE guidelines – https://www.nice.org.uk/guidance/ng23/ifp/chapter/menopause
Useful websites for patients
- Menopause Matters – www.menopausematters.co.uk
- Women’s Health concern – www.womens-health-concern.org
- Manage my menopause – www.managemymenopause.co.uk
Office for National Statistics 2019 www.ons.gov.uk/employmentandlabourmarket/peopleinwork/employmentandemployeetypes/bulletins/uklabourmarket/may2019
NHS Employers 2018 www.nhsemployers.org/-/media/Employers/Images/2018-D-and-I-infographics/Gender-in-the-NHS-2018.pdf
National Survey, The Results, British Menopause Society, https://thebms.org.uk/wp-content/uploads/2016/04/BMS-NationalSurvey-MARCH2017.pdf