HNY Policy and Pathway Repository - Humber

This is a consultant led specialist service taking referrals for the more complex women requiring menopause care including the following:

• Poor symptom control after trial of 3 different HRT preparations
• Requesting HRT who have contraindications or complexities excluding focal migraines or cardiovascular disease.

• Premature ovarian insufficiency – the presence of menopausal symptoms and elevated follicle-stimulating hormone levels which has been identified on two blood samples taken 4-6 weeks apart in a woman younger than 40 years old

• Requesting testosterone for low sexual desire after establishment of Oestrogen replacement for at least 6 months and having received adequate treatment for Vulvo-vaginal atrophy

• Post Menopausal Bleeding - 2WW Pathway
• Breast Lump - 2WW Pathway

Exclude Red Flag Symptoms

• Unexplained vaginal bleeding
• Post coital bleeding
• Postmenopausal bleeding
• Undiagnosed breast lumps

Do Not Refer

Healthy and fit women aged 40 years or over with menopausal symptoms and non-complex medical issues.

Menopause treatment with past or current focal migraine or cardiovascular disease

Requesting to discontinue HRT.

Fitting or change of LARC for menopause reasons.

Post menopausal bleeding (due to risk of malignancy should be referred via appropriate cancer pathway)

Contraception including LARC for fertility control only.

Psychosexual only – refer to counselling services.

Requesting testosterone without evidence that a biopsychosocial approach has excluded other causes of low sexual desire

NICE Guidelines on Menopause (Nov 15)

British Menopause Society Fact Sheets

Women aged 45 years or over with menopausal symptoms and no complications can be prescribed HRT in Primary Care without any need for investigations or referral. This can be systemic HRT and/or local HRT. Women need clear information on symptoms, benefits and risks of the different treatment options and contraception if premenopausal.

Women with unexplained amenorrhoea under 40 years should be referred, see inclusion criteria above.

Referrals

e-Referrals please note this is for indirect booking only please issue the client with their ID number and ask them to ring 01482 247111 after 48hrs to initiate the referral.

Completed Healthcare Professional Referral form on ARDENS can be sent via email to CHCP.247111@nhs.net  or postal.

*Please Note: referrals from GP or Health Care Professional must be completed in full with the relevant requested information attached, failure to provide this will result in delay of appointment for client*

• www.menopausematters.co.uk
• www.womens-health-concern.org
• NHS home

• A list of current medication (including contraception) and any relevant past medication
• Any investigations or diagnostics already undertaken and the results of these as the service cannot access these results via SystemOne
• Any significant operations including hysterectomy and sterilisation