As a patient or a nurse we generally never think about money and our health care. Our NHS is free at the point of delivery and available to most people living in the UK. However we know in recent times our wonderful NHS has been under significant pressure, whilst the NHS offers great treatment when we need it urgently or acutely, if I break my leg I can be seen and treated, however a Covid and a variety of other issues have led to long waiting times and delays in treatment that isn't considered an emergency.
This is particularly relevant in the area of women's health and gynaecology, waiting times across the UK can vary based on where you live, NHS guidelines suggest for a non urgent referral the waiting time should be 18 weeks. However what I hear from my patients is that this is not the case with many waiting at least 6-12 months. Whilst many patients understand the rationale for the long waiting list the practical daily lived experience is something very different.
I have spoken with a few patients this week who have recently been diagnosed with POI ( a premature menopause before the age of 40) They were given this devastating and life changing diagnosis at their GP's. Their GP also followed the correct evidence and guidelines referring the patient to a specialist gynecologist for further support and treatment. Normally the patient would have been seen by a specialist within a reasonable period of time, however this is not what is happening with patients waiting 6-12 months to see a specialist and begin treatment.
Waiting a year without any medication or specialist advise is a long time. Imagine you are a patient in your teens, twenties, or thirties who may be experiencing menopause symptoms such as hot flushes or brain fog, anxiety, vaginal dryness, low libido or itchy skin. You could be still working or studying trying to keep going to work each day struggling with a variety of different symptoms. Your friends and piers may not even have heard of the term menopause or the symptoms. With no medication to help with the symptoms and no support a year is a long time to wait and we haven't even considered the long term impact of menopause at a younger age.
For women who experience a menopause under the age of 40, hormonal medication, specialist treatment and referral is of paramount importance, not just to help with the symptoms but also because of the long term implications of a premature menopause. Women who experience a premature menopause are more likely to have a risk of developing osteopenia (brittle bones) cardiac issues, cognitive changes and are at increased risk of diabetes, we have good evidence that supports this see the NHS website - https://www.nhs.uk/conditions/early-menopause/.
There is also the emotional impact of a premature menopause and the impact on future fertility, both requiring specialist support and further advice. How can we ask these women to wait at least a year without support or any treatment? We don't know what the long term implication is on both their physical and emotional health?
What we find is more women turning to the private sector for help, this means privately funding healthcare appointment, medication, investigations and future treatment. I have spoken to many women who are doing this, ranging from investigations such as hormonal blood tests to medical consultations. This can mean accessing that vital support and treatment avoiding a delay, but this is not always possible for everyone to afford private treatment or sustainable in the long term.
What can we do and what does the future hold? The long term goal would be to reduce waiting times and have more specialised clinics where younger women can be referred to. Providing further education to GP's, primary care staff and other health care professionals is also a must so that younger women don't come away being told they are to young for menopause. The European Society for Human Reproduction and Embryology (ESHRE) has written some fantastic POI guidelines https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Management-of-premature-ovarian-insufficiency.aspx and the NHS NICE menopause guidelines https://www.nice.org.uk/guidance/ng23 also offer good advise for menopause in younger women, health care professionals must be made aware of these guidelines.
At present around 1% of the general population will experience menopause before the age of 40, recent data has suggested this figure has been underestimated and could be as high as 3.5% (Zhu 2022), so this could mean many more women needing the right help, support and treatment going forward.
Reference Zhu, M. (2022) The global prevalence of premature ovarian insufficiency: A systematic review and meta analyisis; Climetric.