NHSGGC Menopause Referral Guidance

Gynaecology and Sandyford Services both accept referrals from GPs, Primary Care ANPs and from secondary care

Referral may result in an advice letter from the service rather than a patient appointment

Individuals with medical conditions that complicate or contraindicate use of hormone replacement therapy (HRT).  This includes, but is not limited to:

• breast cancer
• oestrogen-responsive cancers
• venous thromboembolism
• cardiovascular disease
• severe endometriosis

In addition, refer

• individuals using HRT who have bleeding problems, side effects, or refractory symptoms
• individuals with premature ovarian insufficiency (<40yrs) – spontaneous or iatrogenic              Guideline on the management of premature ovarian insufficiency
• adults with Turner Syndrome to Gynaecology at Glasgow Royal Infirmary or QEUH (FAO Dr Aparna Sastray).

• Individuals with uncomplicated medical history who request Hormone Replacement Therapy (HRT) – see GGC Formulary for available HRT preparations, and our Primary Care Management FAQs for further guidance
• Individuals with new onset unscheduled bleeding in the first 3-6 months of use of HRT

• Refer those aged under 16 to Paediatric Endocrinology (FAO Dr Avril Mason RHSC)
• Individuals with premature ovarian insufficiency who wish to explore fertility options should be referred to Assisted Conception Unit, Glasgow Royal Infirmary. If they do not wish to consider pregnancy, then refer as usual to menopause services
• Individuals established for ≥6 months on an HRT preparation who develop new or worsening unscheduled bleeding, refer via the Gynaecology USOC/one stop pathway
• Anyone considering prescribing testosterone and requiring advice (see FAQ 23. Can I prescribe testosterone and Appendix 1) should, contact Sandyford via the email advice
  ggc.menopausesupport@nhs.scot

• Use SCI Gateway to refer to either menopause services, acute gynaecology or Sandyford Services as appropriate
• Unless specified at section 4, the decision about which service to refer to will depend on patient, clinician and location preferences
• There are no differences in time to be seen therefore please do not make concurrent referrals to both services

FAQ: Primary Care Management

For clinicians

• British Menopause Society. Wide variety of ‘tools for clinicians’ and fact sheets on various topics e.g. HRT preparations & alternatives, CBT, migraine, HIV and testosterone
• NICE Guideline Menopause: diagnosis and management

For Patients

• NHS Inform Women’s Health Platform has a range of information on Menopause including a suite of short videos including one highlighting personal stories of women affected. Resources are available in 5 other community languages Arabic; Chinese; Polish; Punjabi and Urdu; as well as Easy Read and British Sign Language 
• The Daisy Network provides information and support to women diagnosed with Premature Ovarian Insufficiency (POI) also known as premature menopause.
• Menopause Matters independent website providing information about the menopause, menopausal symptoms and treatment options offers email and telephone support for women's health and has a wide choice of patient information leaflets on menopause and other women’s health conditions
• Women's Health Concern offers email and telephone support for women's health and has a wide choice of patient information leaflets on menopause and other women’s health conditions

Appendix 1: GGC Prescribing Advice: Testosterone in Menopause