CHAPTER 8 - Post-reproductive gynaecology

Summary

Key points

1. ✓ Post-reproductive care needs to be coordinated by a regional specialist team integrating primary and secondary care.

2. ✓ Care should not be delivered in general gynaecological clinics by mainstream gynaecologists.

3. ✓ Specialist care can be delivered in a variety of settings: hospital, community-based sexual and reproductive healthcare clinics and outreach services in primary care.

4. ✓ A local lead clinician should be identified, who may be a hospital gynaecologist, sexual and reproductive health specialist or general practitioner with a special interest.

5. ✓ Medical and nursing staff need to be trained and to maintain expertise through regular attendance at updating courses.

6. ✓ Job plans need to include time for continuing training and for liaison between primary and secondary care.

7. ✓ Dedicated telephone, answerphone and email contact systems for women and health professionals need to be maintained.

8. ✓ The specialist team needs to link with allied health professionals who are involved in the care of postmenopausal women, such as radiographers, physiotherapists and continence advisors.

9. ✓ The specialist team need to link with other specialties such as endocrinology, oncology, fertility and rheumatology to provide a ‘one stop’ service for women with special needs, such as early menopause, estrogen-dependent cancer and osteoporosis.

10. ✓ A regional database of women with a premature menopause should be in place and these women should normally be offered HRT until the average age of the menopause (51 years).

Introduction

The menopause can now be considered to be a mid-life event as the lifespan of women in the UK continues to increase. Many women now survive well into their tenth decade. Thus, both the short- and long-term problems of the menopause, both for the women themselves and for society, are key issues for health professionals. The multifaceted ‘model of care’ concept defining how health services are delivered for the menopausal woman is a model integrating primary and secondary care to deal with the multiple problems which can affect post-reproductive health.

In the UK, unless surgery is required, most post-reproductive gynaecological care is delivered in the primary care setting. Only women with complex issues or who fail to respond to treatment are referred to specialist services. Currently, there are few NHS dedicated clinics for post-reproductive health. These are located either in hospitals or, increasingly, in community-based sexual and reproductive health services; consequently, general gynaecologists may be delivering this service, with resulting concerns about expertise and training. The RCOG Standards for Gynaecology specifies that post-reproductive health should be managed by a dedicated team.