Menopause: identification and management

The HRT review for 8 patients, including discussion session, individualised care plans and documentation, could be undertaken in a similar time that would be needed for 8 individual HRT reviews. It is believed this can be reduced in the future, in particular the time needed for the GP.

Patients were able to share experiences and compare approaches.

All participants signed up to respect each other's confidentiality and confirmed this verbally at the start of the session.

As well as the group presentations and discussions, each patient received an individualised care plan, including medication changes.

The results from patients completing the simple evaluation form were as follows:

Invitation process: a key to the success of the session was a small telephone campaign by 2 experienced members of the admin team, targeting patients that were due their 3-month or 12-month HRT medication review. This targeted patients that had already had an initial menopause or perimenopause consultation and were therefore more likely to be confident about sharing their experience with others. The benefits of a group session were outlined, concerns dealt with, and reassurances made about confidentiality. Holding the clinic on a Saturday morning was found to be positive for some patients, but negative for others depending on their commitments. It was important to indicate the likely maximum time commitment (2 hours for patients), although at the sessions, patients seemed happy to stay longer. Approximately 50% of patients contacted were willing to take part, and 10 were booked to allow for some last-minute cancellations (2 cancelled).

Benefits of group discussion: it was found after a gradual start that patients were willing to speak openly and enjoyed sharing experiences and ideas. One example, in a discussion about physical activity, a participant who wanted to commence weight training but lacked confidence to start was given details of a local subsidised gym programme by another woman in the group, and they exchanged contact details so they could support each other to take part. The group environment was a safe place for similar age women regardless of background and ethnicity to talk about problems which affect them all to some degree.

Format: the format of the session worked well for a pilot process. It was felt that, in future, the GP would be able to leave the session for 20 minutes to allow the discussion to continue a bit longer and then return to coordinate a sum up. In general, it was felt that with practice the session time and GP time could be reduced and still maintain positive outcomes.

Individual health plans: it was found that with careful notes, and checking and summarising, individual plans could be developed. Any final questions were resolved at the end.

Future potential: the benefits of this approach are now being shared with the patient population through social media and text invites to women due for their next HRT review. Women attending traditional one-to-one consultations will also be offered group consultations for their future reviews. Group consultations will now be scheduled monthly. In addition, options are being developed for scheduling focused group sessions for women affected by oestrogen-dependent cancer, especially breast cancer, to share their concerns and solutions, as well as women from ethnic or religious groups where discussion of women's health needs to be particularly sensitive.