NHSGGC Menopause Referral Guidance

Warning

1. Who can refer?

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

2. Who to refer to Specialist Menopause Services

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).

3. Who to manage in Primary Care

  • 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

4. Who to refer elsewhere

  • 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

5. How to refer

  • 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

6. FAQ: Primary Care Management

7. Resources and Links

For clinicians

For Patients

8. Appendix 1: GGC Prescribing Advice: Testosterone in Menopause

9. Appendix 2. Referral Guidance Development Group Members

 

Name

Designation

Dr Kay McAllister

Consultant Sexual and Reproductive Health, Sandyford Services

Dr Chris Johnstone

Associate Clinical Director, Renfrewshire HSCP Medical Directorate

Dr Jenifer Sassarini

Consultant Gynaecologist, Women and Children’s Directorate

Dr Sarah Woldman

Consultant Gynaecologist, Women and Children’s Directorate

Dr Vanessa McKay

Consultant Gynaecologist, Women and Children’s Directorate

Dr Maureen Byrne

GP and LMC Chair

Dr John Ip

GP and LMC Medical Director

Fiona Russell

Advanced Prescribing Support Pharmacist, Glasgow City HSCP

Louise Carroll

Programme Development Manager, -Woman’s Health Plan, Public Health

 

Editorial Information

Last reviewed: 01/05/2023

Next review date: 01/02/2025

Author(s): Consultant Gynaecologist in Sexual and Reproductive Healthcare et al.

Version: 1.0

Approved By: Glasgow LMC; Primary Care Clinical Advisory Group; Gynaecology Governance Group