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Referrals to UHBW Menopause Clinic (DRAFT)

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Referrals to Menopause clinic

Referrals to the menopause service at UHBW are through eRS.

All referrals are triaged; advice and guidance may be provided instead of a clinic appointment. Those offered an appointment will be booked into the appropriate clinic (complex or oncology). Appointments cannot be expedited as all women referred are struggling with symptom control and complex conditions.

The current waiting time for a clinic appointment is 6 months – in part this is due to 1/3 of our referrals being for consideration of testosterone therapy.

If referring for HRT treatment resistance, please summarise their prior and current menopause therapies and ongoing symptoms
Make it clear WHY you are referring – which menopause service referral criteria do they meet.
Referrals will be rejected if a list of consultations is sent rather than a referral summary letter – advice and triage is not job planned and trying to assess the reason for referral from a list of consultations is not always obvious.
If referring for testosterone therapy – include the baseline testosterone levels in the referral (or it will be rejected) and what has been done to optimise symptoms before referring.

**If testosterone therapy is started through a private provider they need to complete the baseline, 3 months and 6-month follow-up before referral to the clinic for potential ongoing assessment will be accepted.

Referral Criteria are:

HRT treatment resistance: ongoing symptoms despite trialling different preparations and dosages (please list in referral)

Side effects leading to cessation such as progestogen sensitivity (despite trialling different preparations and ensuring oestrogen optimisation – please list) or unscheduled bleeding (with normal investigations which has not responded to measures as outlined in the BMS guideline).

Premature Ovarian Insufficiency (this can be managed in primary care if there is a menopause specialist who can undertake the counselling / investigations for causes and health effects, contraception, fertility aspects and symptom management)

Medical comorbidities where oestrogen therapy can have deleterious effect such as Lupus, Epilepsy, Porphyria, unprovoked thrombosis, Fibroids, Endometriosis, Unstable liver disease, Connective tissue disorders, Histamine Sensitivity

Risk reducing surgery pre-operative menopause counselling such as for BRCA / Lynch.

Women with symptoms of menopause and a history of breast or an oestrogen receptor positive cancer (see Hormone sensitive cancers and Breast conditions): please include receptor status, Grade, year of diagnosis and any ongoing adjuvant therapy if taking.

Please review individual remedy pages for advice regarding referrals in specific groups. Follow advice on these pages:

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.