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Menopause Advice & Guidance (A&G) Service (Pilot) - Devon
Key Messages
The Devon Menopause A&G Service (Pilot) will provide specialist advice and guidance support relating to the management of menopause symptoms to Primary Care Clinicians across Devon.
This service will be provided by Sexual and Reproductive Health Consultants and British Menopause Society trained GPs.
The response time back to General Practice will be within two weeks. This will be extended to three weeks in the case of reduced service capacity or excessive demand, verified by the commissioner (NHS Devon ICB).
Guidance on the management of menopause can be found here:
Guidance on the management of menopause - North & East (devonformularyguidance.nhs.uk)
Scope
- Patients whose symptoms are not controlled after two HRT preparations tried for a minimum of 3 months per preparation
- Patients with complex histories where safe prescription of HRT is unclear
- Patients with confirmed diagnosis of premature ovarian insufficiency (iatrogenic or spontaneous) where management advice is required
- People with persistent unscheduled bleeding less than six months after starting HRT or less than six months after changing HRT preparation
Please see the ‘Red Flags’ section to ascertain if urgent suspicion of cancer referral is required.
Out of Scope
- Postmenopausal bleeding
- Bleeding where there is suspicion of cancer or risk factors for cancer.
Please see the ‘Red Flags’ section to ascertain if urgent suspicion of cancer referral is required.
Referrals submitted without this information may be returned.
History
- a copy of the patient’s medical history
- current medication
- any allergies
- smoking status
- relevant family history (breast cancer, ovarian cancer, Lynch syndrome, VTE, Cowden syndrome, endometrial hyperplasia/cancer)
Examination
- recent blood pressure
- BMI
Include symptoms suggestive of:
1. Endometrial cancer
Not taking HRT:
a. women with an intact uterus with post-menopausal bleeding (unexplained vaginal bleeding more than 12 months after menstruation has stopped because of the menopause)
Taking HRT - unscheduled bleeding with concern of endometrial cancer:
a. Unscheduled bleeding in a postmenopausal woman persisting for more than 6 months after starting HRT
b. Unscheduled bleeding in a postmenopausal woman persisting for more than 6 months after a change in HRT
c. Bleeding persisting more than 4 weeks after stopping HRT
d. Unscheduled bleeding in women on HRT with a family history of endometrial hyperplasia, endometrial cancer, Lynch Syndrome or Cowden syndrome, or in women with a BMI of over 40.
e. Endometrial thickness of greater than 4mm on continuous combined HRT
f. Endometrial thickness of greater than 7mm on sequential combined HRT
g. Other unscheduled bleeding on HRT with GP cancer concern (outside of guidelines)
Please consider coil removal (affects endometrial thickness measurements) and an up-to-date FBC prior to referral
Please include all relevant recent investigation results (for example but not limited to ultrasound reports, hormone profiles and histology results) and clinic letters
This service does not have access to results, letters or healthcare records
Guidance on the management of menopause:
North & East Devon Prescribing Formulary
Guidance on the management of unscheduled bleeding on HRT:
Referral Criteria
- Patients whose symptoms are not controlled after two HRT preparations tried for a minimum of 3 months per preparation
- Patients with complex histories where safe prescription of HRT is unclear
- Patients with confirmed diagnosis of premature ovarian insufficiency (iatrogenic or spontaneous) where management advice is required
- People with persistent unscheduled bleeding less than six months after starting HRT or less than six months after changing HRT preparation
Please see the ‘Red Flags’ section to ascertain if urgent suspicion of cancer referral is required.
Referrals submitted without this information may be returned.
History
- a copy of the patient’s medical history
- current medication
- any allergies
- smoking status
- relevant family history (breast cancer, ovarian cancer, Lynch syndrome, VTE, Cowden syndrome, endometrial hyperplasia/cancer)
Examination
- recent blood pressure
- BMI.
Referral Instructions
e-Referral Service Selection:
Specialty: GENITO_URINARY_MEDICINE
Clinic Type: Genito-Urinary Medicine
Service: Devon Menopause Service - Barnstaple Health Centre - RH8
Referral Form
GP Information
Please see Formulary guidance on management / prescribing:
Guidance on the management of menopause - North & East
British Menopause Society - Unscheduled bleeding guideline
Peninsula Cancer Alliance webinar about bleeding
British Menopause Society - Progestogens and endometrial protection
NICE - Hormone replacement therapy (HRT)
Devon Sexual Health - Professionals Menopause Information
Patient Information
Devon Sexual Health - What is the menopause?
Pathway Group
This guideline has been signed off by NHS Devon.
Publication date: October 2024
