How do GPs experience the menopause?

Problem

Menopause is a normal part of ageing but has the potential to significantly impact the working lives of women, with symptoms forcing some to leave their jobs. Research suggests symptoms such as hot flushes are difficult to manage at work, yet doctors are reluctant to discuss menopause with employers. Female General Practitioners (GPs) may be struggling in silence and missing out on vital support, with menopause potentially contributing to a GP workforce crisis. Our aim was to explore how menopause impacts the lives of female GPs and consider how the NHS could better support them.

Approach

GPs were recruited via social media accounts of the Unit of Academic Primary Care and the supervising GP. Recruitment was voluntary and exclusively NHS GPs or trainees, currently experiencing (peri)menopause symptoms (or within previous 5 years). Interviews on Microsoft Teams were arranged via email; these were semi-structured using a topic guide. Interviews were video recorded and auto-transcribed by Microsoft Teams, with transcripts checked for accuracy. Transcripts were qualitatively analysed using thematic analysis, with inductive codes developed and translated to key themes. NVIVO data management software was utilised.

Findings

Most frequent symptoms from the 19 GPs interviewed were sleep disturbances; brain fog; hot flushes; anxiety; night sweats and mood changes. Symptoms were often attributed to stress rather than menopause. The impact was apparent at home and work, but most participants believed employers could offer little support so did not discuss symptoms at work. Some participants described a postcode lottery for hormone replacement therapy, especially testosterone, making them seek private treatment. While most participants used HRT, others did not due to perceived risks. Self-management strategies included exercise, mindfulness, and rationalisation of symptoms.Participants described their lived experience of menopause positively impacting their care of menopausal patients. Changes for improved menopause care included training (especially for male GPs), increased awareness of HRT benefits, and menopause policies.

Consequences

Our results show GPs suffer a range of menopausal symptoms, with the impact being as significant as making them feel unsafe to continue their jobs, taking time off sick or changing roles. Due to a perceived lack of support available, they are reluctant to discuss menopausal symptoms. Menopause policies would increase awareness of support available and promote an open line of communication, free from judgment and discrimination. Additionally, the Practitioner Health service was invaluable to participants who utilised it. Within the proposed policy, it would be useful to highlight eligibility for this service. Regarding the postcode lottery, research may be required on HRT availability, with variability between CCGs explored, to ensure equal access. Additional research may be required on testosterone to ascertain whether it should be more widely available on the NHS.