The Middle Years Group: a holistic approach to the management of the menopause in primary care
Introduction
With increasing longevity, the importance of the menopause has never been more profound. Oestrogen deficiency may cause major physical and psychological symptoms [1]; long-term effects on arterial disease and osteoporosis carry a high morbidity and mortality [2], [3]. Hormone replacement therapy may reverse these effects and, as life expectancy increases, women at risk have more to gain by treatment [4]. The menopause, however, is a natural process and many women do not wish to take drug treatment for it. The risk/benefit ratio varies sharply between individuals [5] and in-depth discussion of all the issues are needed before a woman can make a decision [6].
The problem for general practitioners is how to allow all those at risk to make an informed decision on hormone replacement treatment. How to deliver it to those who want and need it, but not inflict its adverse effects on the unwilling with little to gain.
There is more to the middle years than hormones, they just add to the potential maelstrom of problems which may occur at this time of change. Women may be coping with teenage children or departing young adults, caring for elderly relatives and possibly bereavement. Marital relationships may be strained by many issues, including the realisation that fertility is over. Retirement may not be far away. There may be a sense of wonder about what life has offered so far and where it is all leading. Health problems such as cancer and heart disease become a less distant prospect.
These common problems were seen from differing angles by the health visitors, doctors and counsellor in our practice. This realisation of an unmet need culminated in the Middle Years Group being conceived. The group was organised by the health visitor and counsellor. It ran between January 1992 and July 1995.
Section snippets
Materials and methods
All female patients aged 45–55 years were identified by the computer age/sex register and a written invitation was sent to attend a series of four meetings, each of 90 minutes, run in the surgery in groups of 12–16 people. The sessions were run as follows:
- 1.
Introduction. The health visitor and counsellor worked together in a flexible way to enable the group to establish itself. Confidentiality was stressed to enable the group to safely raise their questions and concerns.
- 2.
Physical health issues.
Results
Invitations were sent to 1414 patients. One hundred and sixty-three attended the groups (12%). All those attending, without exception, found the meetings helpful. Asked which session was the most useful: 32% said all, where a preference was expressed the session on HRT was most frequently chosen. Attenders stated that it provided factual information which was particularly helpful. Equally the benefits of airing and sharing problems within a group were important to others. The health visitor and
Discussion
The Middle Years Group was seen as a success by everyone involved. The patients were enthusiastic; the counsellor and health visitor felt that fundamental problems were being addressed appropriately. The doctors enjoyed the opportunity to talk to patients without the time constraints of normal appointments. It only involved a few sessions per year; each session got a lot of information over to approximately a dozen patients at a time.
The impact of attending the group was largely neutral on HRT
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