Referrals and coordination of care for early menopause

Women diagnosed with early menopause (EM) often need to see different health practitioners, for example obstetrician-gynaecologists, endocrinologists, psychologists and fertility specialists, as well as a general practitioner (GP), depending on their symptoms. Women experiencing EM after cancer treatment often need to also consult gynae-oncologists or medical oncologists, breast surgeons and breast care nurses. When lifestyle changes such as diet and exercise are recommended, women experiencing EM may need referrals to dietitians and exercise physiologists (see Lifestyle changes following early menopause).

The health practitioners we interviewed discussed their experiences of referring women to different services and specialists and offered their thoughts on some of the difficulties, as well as positive changes, in the coordination of care for women with EM.

Dr Ee, an integrative general practitioner, shared her experience of referring women to specialists.

The role of the GP

Several health practitioners felt that GPs were central to the care of women diagnosed with EM. Breast surgeon Dr Baker said: ‘[GPs] are the primary care physician – which should also be a preventive care physician’. Most also noted the importance of the GP in monitoring long-term health impacts (see Long-term health effects of early menopause) such as loss of bone density and cardiovascular issues. However, health practitioners also explained that the time constraints of GP consultations can sometimes make it challenging to provide good quality care.

GP Dr Goeltom shared her experience of the time constraints when seeing women experiencing EM.

Barriers to multidisciplinary care

While several health practitioners commented on the value of multidisciplinary care, a few noted that, when referring women to different services, communication between specialists could be difficult.

Using the example of menopause clinics Dr P, a breast surgeon, described the limitations of the current referral system.

Endocrinologist Dr W explained the difficulties of communicating via written referrals and shared her thoughts on the lack of support for patients navigating between different practitioners.

Referrals for psychological therapies

Several health practitioners discussed referring women experiencing EM to psychologists if they were experiencing emotional or psychological distress; a few noted that the cost of visiting such specialists can be a barrier for some women.

For endocrinologist Dr D, referrals to psychologists is important but must be done with ‘consideration’ for the individual woman’s preference and may also involve the GP.

Professor Kulkarni, a psychiatrist who specialises in women’s mental health, explained that improvements are needed in referrals to psychiatrists and emphasised the importance of a ‘holistic approach’ to care.

Fertility specialists

The importance of referring women diagnosed with EM to fertility specialists (see Fertility and early menopause) was mentioned by several health practitioners. Dr Stern, a fertility specialist, reflected that women diagnosed with spontaneous EM in particular are now ‘referred early’: ‘we have early and prompt referral … everyone understands now that it’s negligent to not even have the discussion… we’ve got much more awareness, much more proactive approach’.

Referrals in regional areas

A few health practitioners commented on the difficulties of referrals in regional areas, including the lack of specialists and menopause clinics (see Menopause clinics), and the need for women experiencing EM to travel long distances to get appropriate care.

Dr Barker, a general practitioner based in a regional area, commented on his experience of referring women to specialists.

Coordination of care for women experiencing EM following cancer treatment

Some practitioners commented that GPs are particularly important for women experiencing EM symptoms after cancer treatment because of the complexity of cancer care. As breast surgeon Dr P explained, ‘the GPs do pick up … bone density and … heart disease prevention … I think what happens in the oncology world is that there’s so much to do around the actual cancer itself’.

For Dr Baber, an obstetrician-gynaecologist, the general practitioner is central to the coordination of care for women diagnosed with EM following cancer treatment.

Further information

Talking Points (Health Practitioners)

Talking Points (Women)

Other Resources