GLASGOW, Scotland — An interactive digital decision tool that individualizes menopause care received praise from primary care clinicians in the United Kingdom, who said it could improve patient care and streamline office visits.
The tool, called Wellspring, helps clarify menopause guidelines from the UK’s National Institute for Health and Care Excellence (NICE) while fostering shared decision-making with evidence-based data.
”Access to hormone replacement therapy [HRT], as well as decision-making around treatment for menopausal symptoms, is often complicated by concerns around its safety, and there is still a knowledge and a confidence gap among healthcare professionals causing reluctance to prescribe HRT,” said Aini Kamal, MSc, from University College London, UK. Kamal presented results of a survey about the tool at the 2023 annual meeting of the Royal College of General Practitioners.
For the study, Kamal, Daniel Reisel, MBBS, PhD, a gynecologist at UCL, and colleagues evaluated Wellspring with doctors, nurses, and pharmacists.
“Ensuring that women receive education around symptoms, so that they are empowered, is a key part of optimizing their care and sharing decision-making,” Reisel told Medscape Medical News. He added that UK primary care had seen an increase in cases of women presenting with symptoms associated with the perimenopause and menopause at a time when UK Members of Parliament (MPs) are debating whether to make it mandatory for all women to have menopause check-up in their early 40s.
The online survey was completed by 280 participants, and respondents were primarily GPs with several years of relevant prescribing practice. Of those, 93% found information from national guidelines to be accurately presented in the tool, and 97% said they would recommend this decision aid to other healthcare professionals, Kamal reported.
Nearly all participants said they could see themselves using the tool with patients in the clinic or as an adjunct to virtual sessions. “This [finding] was particularly important because it demonstrates the clinical potential this tool has,” she said.
One Consult, Too Many Problems
Louise Newson, MBChB, who runs the UK’s largest menopause clinic, said primary care appointments are often time-pressured and follow a “‘one problem-one consultation'” policy. As such, women are often thinking ‘Do I go with my joint pains, or my palpitations, tinnitus, or what?’ If a patient presents with tinnitus, a doctor might focus on the potential of an inner ear problem rather than a hormone deficiency, but I do know that if the woman is perimenopausal or menopausal, we often look to replace the missing hormones, and then if the tinnitus doesn’t improve we can revisit the ear problem.”
Newson noted that 17% of women in her clinics have had more than six GP visits in the year before she sees them, but in the year following, this figure drops to 1%. Acknowledging that a menopause consultation for a GP is time-consuming, Newson pointed out that taking time initially with the patient “means it will reduce the number of future consultations quickly, but more importantly, we also know that taking HRT reduces long-term risk of serious diseases, including heart disease and osteoporosis.”
The digital tool can be used by both doctors and patients to help women work through their symptoms and equip them with knowledge so their GP visits are more productive.
“When we see women who are empowered with knowledge [about menopause symptoms], then the consultations are quicker and essentially place the patient central to the discussion,” Newson said.
Ed Russell-Smith, MBChB, a GP in Scotland who moderated the session, said the tool “lays out a nicely structured approach and provides modern treatment options, and resources for patients.”
However, he added “we also need to remember there are potential harms to be done from HRT too. It’s vitally important that while patients might see HRT as a panacea, doctors need to balance this with the risks involved for each individual. As a tool, I think Wellspring can help us in this respect to apply general principles to that patient and individualize treatment.”
Reisel, Newson, Kamal, and Russell-Smith disclosed no relevant financial relationships. The Wellspring Decision Aid was supported by UCL’s Institute for Women’s Health. The Newson Health clinic is fully private, but research is done via the nonprofit arm, which is supported by the clinic. There is no pharma involvement.
Royal College of General Practitioners Annual Meeting. Presented October 20, 2023.
Becky McCall is a freelance medical journalist based in London, UK. She has written for Medscape for nearly 15 years.
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