The BMS Recommendations “ A blueprint for preventing and managing the problems of the menopause” Nick Panay Immediate Past Chairman, BMS Consultant Gynaecologist, Imperial College London with gratitude to….. Edward Morris, Consultant Gynaecologist, Chairman, BMS Norfolk & Norwich University Hospital, UK Anthony Mander, Consultant Gynaecologist, Oldham, UK BMS council and trustees

An Increasing Need  Women now spend nearly 1/2 of their lives in a postmenopausal state  Number > 50y of age in UK WomenMenTotal 2003 Actual m 2031 Expected ONS, 2008

Is there a problem?  Ageing population  Increasing obesity  Increasing chronic disease e.g. diabetes, cardiovascular disease, osteoporosis, dementia …..and at the same time there is….  Less availability of menopause clinics & staff!

BMI by Age

The UK NHS White Paper (published 12 th July 2010)  Set out how we will “Put patients at the heart of the (New) NHS” Focus on improving things that really matter to patients – the outcome of their healthcare Empower and liberate clinicians to focus on  Innovation  Freedom to focus on improving healthcare services An opportunity for the BMS to take the lead to optimize midlife women’s healthcare

BMS recommendations  Principles of recommendations  The BMS believes that …. Practical approaches should be adopted to prevent early/avoidable deaths Women should be empowered to live as full, healthy and active a life as possible

BMS recommendations  The BMS believes  Most women are unaware of the impact of menopause on their health and that simple improvements can protect them from serious health problems.  If women are properly risk assessed and educated to improve their risk profile they will lead longer healthier lives

“The focus is on how we can improve health and well-being, instead of waiting until people are sick before we help them”

“This shocking variation in early and unnecessary deaths means people’s lives are needlessly cut short and that cannot continue unchecked” Jeremy Hunt, 11 th March ,000 die prematurely each year, 103,000 are classed as preventable!

Key BMS Recommendation  Primary Care Teams invite women on their register, around the time of their 50th birthday, to attend a health and lifestyle consultation in order to discuss a personal health plan for the menopause and beyond

What does this mean?  A woman at 50 Unless symptomatic, has no reason to visit her GP except for routine smears Found to to have BMI>35 Work through risk factors and counsel appropriately Highlight raised BMI being associated with  CVD, Stroke, hypertension and diabetes  Breast cancer, endometrial cancer  Worse hot flushes than women with a normal BMI. In raising these issues women may feel motivated to reduce their risks, reduce healthcare resource utilisation and ultimately cost to health services

BMS Recommendations for optimising Midlife Health and beyond Advice to Women o Exercise, a sensible diet, moderation of alcohol intake, smoking cessation, appropriate weight loss and blood pressure control are all recognized factors that reduce heart disease risk o These simple measures can also reduce the risk of other serious diseases such as osteoporosis, breast cancer and dementia.

Davis SR, Castelo-Branco C, Chedraui P, et al. Understanding weight gain at menopause. Climacteric 2012;15: World Menopause Day “ Studies mostly indicate a reduction in overall fat mass with HRT, improved insulin sensitivity and a lower rate of development of type 2 diabetes” The Role of HRT in prevention

BMS Recommendations for optimising Midlife Health and beyond Advice to Policy Makers - Osteoporosis  The major causes of disability in women aged over 45 are disorders of the bones and joints, including arthritis and osteoporosis.  We recommend that all local health communities should have an osteoporosis strategy and ensure that the prevention, detection and treatment of osteoporosis are effectively managed.

BMS Recommendations for optimising Midlife Health and beyond Advice to Policy Makers – Cardiovascular Disease  The rate of cardiovascular disease doubles in the menopause and eventually affects more than 50% of women. Gender specific information is needed e.g. the role of Statins, HRT etc  We recommend that within the government’s plans to reduce deaths from coronary heart disease (CHD), special attention should be given to strategies for primary and secondary prevention of CHD among women

BMS Recommendations for optimising Midlife Health and beyond Advice to Policy Makers – Cancer  Detecting and treating cancer in women remains a high priority  Much work has been done to improve screening, detection and treatment. However, it remains a major fear for large numbers of women.  We support the government’s commitment to reduce deaths from cancer through extension of screening and education programmes.

BMS Recommendations for optimising Midlife Health and beyond Advice to Policy Makers – Premature Menopause  Women who have undergone premature menopause are at greater risk of osteoporosis, cardiovascular disease and cognitive decline  We recommend to the Department of Health that a Premature Menopause Register should be established as a priority.

Submit data to the POI registry

BMS Recommendations for optimising Midlife Health and beyond Advice to Policy Makers – Cost Effective Management of Menopause - NICE Guideline!  We recommend that the National Institute for Health and Clinical Excellence gives early attention to the conditions which most frequently affect women over the age of 45 and develops guidelines in relation to these as a priority  NICE has now been commissioned by the DoH to develop a guideline on Diagnosis and Management of Menopause by 2015 – leading to Quality Standards / QOF

BMS Recommendations for optimising Midlife Health and beyond Advice to Policy Makers – Hormone Replacement Therapy  We recommend to the Department of Health that they should provide clear, objective information about the benefits and risks of hormone replacement therapy, as they are known at the present time.  This would reduce confusion and misinformation for both health-care professionals and women.  The BMS/WHC has just produced guidelines on HRT for health professionals, women. This information will be submitted to the DoH/NICE.

The decision whether to use HRT should be made by each woman having been given sufficient information by her health professional to make a fully informed choice. The HRT dosage, regimen and duration should be individualised, with annual evaluation of pros and cons. Arbitrary limits should not be placed on the duration of usage of HRT; if symptoms persist, the benefits of HRT usually outweigh the risks. HRT prescribed before the age of 60 has a favourable benefit/risk profile. KEY POINTS 1

It is imperative that women with POI are encouraged to use HRT at least until the average age of the menopause If HRT is to be used in women over 60 years of age, lower doses should be started, preferably with a transdermal route of administration. It is imperative that in our ageing population research and development of increasingly sophisticated hormonal preparations should continue to maximise benefits and minimise side effects and risks. This will optimise quality of life and facilitate the primary prevention of long-term conditions which create a personal, social and economic burden. KEY POINTS 2

HOT OFF THE PRESS! 6 TH JUNE 2013

Conclusions  We call on The Department of Health to… Promote improved interest and investment in the menopausal health Enforce a routine health check at 50y Expand the availability of menopause support services

Conclusions  The Department of Health must act now to… Optimise the QOL of menopausal women Facilitate their constructive contribution to society Reduce the healthcare burden of chronic disease in the future, to both the individual and society