Menopause

March 7, 2024 felicitybooty

By Seema Bhandri

Following on from Felicity’s post on the perimenopause she asked me to share my own experience of the perimenopause and how it affected me, what I discovered when I researched it and what helped and worked for me, as well as resources I used or have found along the way.

My Story

I went into an early menopause in my early 40’s and only realised when I stopped a hormonal contraceptive pill. I’d had no periods on the pill, which was a normal occurrence on that type of pill, and they never returned, and it was all a bit of a shock when a blood test (FSH) showed I was post menopausal. On reflection my periods had been dwindling in my late 30’s with occasional gaps of 2months here and there. As Felicity eloquently put it you have either stress hormones or oestrogen hormones, and at that time in my life I was busy starting a new career as a GP, and working and adapting was a stressful time. In hindsight I do feel stress played a role in my perimenopause journey.

On writing this I notice a couple of things, firstly, I talk of ‘my’ periods. I see how we relate to our menstrual cycle is very personal. How bothered we are by them, how much we take notice of them, how much we like them or dislike them. The same is true in my clinical experience of the menopause. Everyone is different in how they are with the changes and that can change over time too.

Secondly the shock I felt. I hadn’t anticipated the arrival of the menopause so swiftly. Looking into it I found that 5% of women in the UK experience an early menopause (see below). An early menopause is defined as it occurring between the ages of 40 and 45. Premature ovarian insufficiency (POI) is a menopause that occurs before 40 years old. This is much less common. The shock is and was for me like a grief. At that time and even now I don’t feel we really are that open about that aspect of it.

All that said the symptoms that really triggered me to find out what was going on was not the lack of periods (I had thought the lack was just related to the pill working it’s way out of my system) but forgetting names of people, word finding difficulties and quite overwhelming anxiety. I was also seeing an acupuncturist for sleeplessness. But I hadn’t pieced all together! This is not an unusual feature…. the symptoms being a bewildering array that often we don’t connect together! Thankfully there is much more information out there in the public domain following celebrity publicity (eg Davina McCall) and good sources of information exist now like https://www.balance-menopause.com. 

After the penny dropped I found acupuncture helpful for the hot flushes that were keeping me awake! And within 3 sessions things were improving. And that was partly because acupuncture brought back my periods briefly. And worked well to control my symptoms for several months.

I remember a friend telling me about a book called Natural solutions to menopause by Marilyn Grenville because at that time there wasn’t as much information available online. I used the book to direct me to herbs especially sage tincture initially then I did seek help with a medical herbalist. I tried yoga breathes that were like a dog panting (sitali pranayama) for the hot flashes! I used magnesium for the night cramps and reduce the anxiety/help sleep. I did try over the counter herbal mixtures and they didn’t work as well as a concoction that was directed at my symptoms.

I did some training in functional medicine in 2017 and in the process of doing a gut reset diet I went sugar free and found all my peri menopausal joint pain went and my sleep improved considerably allowing for more tolerance of the remaining hot flushing/night sweats symptoms.

Over time I recognised the more active and stress free I was the symptoms were hardly noticeable. An example was a sabbatical I took where I walked 4-8hours each day. And spent a lot of time outdoors, away from work in the NHS the symptoms were unsurprisingly absent!

I met patients in the NHS managing the symptoms so differently, as I realised what was affecting me I got more interested how patients were managing the thing that I too was trying to get my head around. I met patients who knew, for example, if they did 3 classes of aerobics a week they coped well. Some changed their diet too to great benefit.

Fortunately more and more has been written/spoken about the perimenopause and menopause, and GPs are better equipped (https://thebms.org.uk/education/rcog-bms-menopause-advanced-training-skills-module/  ) to answer questions, sometimes, and maybe more workplaces/society are aware of the profound changes that can occur.

I noticed a big change when the pandemic came along, my symptoms significantly deteriorated and all the usual places I would have gone weren’t available so I briefly for a time went on to HRT from the doctor. Somehow it helped but never really felt like it was what my body wanted….I used to forget to take it and find myself not using it regularly.

As time passed the symptoms have come and gone. I’ve found the strategies that worked for me: changing my diet, managing stress, and most importantly being active, have been the most helpful and loops back to Felicity’s blogpost. I feel it was an opportunity to know my body better, and it was a real reckoning of the toll stress takes. And was part of the unfolding impetus to change careers.

One other book I read was Passage to Power by Leslie Kenton. It was about the menopause being a time for women to come into their own sense of themselves. And around the same time I listened to a radio 4 programme about the whale menopause (https://www.bbc.co.uk/programmes/b07mxv62) which was curious and consolidating somehow.

As much as learning strategies to cope, the menopause changed my perspective of what it was to live with a sense of wellness and integrity of purpose.

Reference

Early and premature menopause

https://www.nhsinform.scot/healthy-living/womens-health/later-years-around-50-years-and-over/menopause-and-post-menopause-health/early-and-premature-menopause/#:~:text=Menopause%20before%20the%20age%20of,before%20the%20age%20of%2045.

Other Resources

Home

https://www.daisynetwork.org for women affected by Premature ovarian Insufficiency

Home

Menopause Wellness Hub

https://www.menopausematters.co.uk

https://www.womens-health-concern.org/help-and-advice/menopause-wellness-hub/

Uncategorized

COVID update January 2022

January 12, 2022 felicitybooty

10th January 2022

High infection rates mean caution is required to keep the practice open. I have reviewed my infection control policy and feel that the level of PPE, cleaning and ventilation of the room should still remain the same.

If you have any symptoms please call to rearrange your appointment. If you have had close contact with someone with COVID, please either cancel your appointment for 10 days or I will need a negative PCR followed by negative lateral flows on the subsequent days since the PCR.

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Covid Procedures

May 22, 2020November 3, 2020 felicitybooty

COVID-19 clinic policy and procedures. Infection risk assessment and mitigation

This document provides a written record of the heightened infection control measures that this clinic has put into place to ensure the safety of all staff and patients during COVID-19.

This risk assessment and mitigation record has been undertaken in conjunction with review of the iO’s guidance ‘Infection control and PPE’ and ‘Adapting practice guide’. In this document you will find the following:

Table 1: This is an overview of the measures we have taken that will form your clinic policy for operating during COVID-19 and available to all staff and patients.

Table 2: Areas assessed for risk and mitigating action taken. This records in detail the areas of potential risk we have identified and record of the mitigating actions we have taken and when.
- Table 2a – Protection for staff and patient before and when in clinic
- Table 2b – Heightened hygiene measures

Table 3: PPE policy for staff in your practice

Table 4: Details of how I have communicated to patients our policies

We have assessed our practice for risks outlined and put in additional processes as detailed below

Undertaken a risk assessment	As of 11th May 2020, I have undertaken a risk assessment of my practice. All patients will be triaged over the telephone to assess for symptoms of COVID 19 in the patient, in the patient’s family, or whether they have been in contact with someone with suspected/confirmed COVID 19 in the last 14 days. Screen for extremely clinically vulnerable patients, or a member of the patient’s family is considered clinically vulnerable.
Heightened cleaning regimes	All Hard surfaces will be cleaned before and after each patient, including chairs, door handles, plinth, pillows, card machine etc. Treatment times staggered to give time to clean the room between appointments. Aeriation of the room: leaving the window open during and after treatments.
Increased protection measures	All linen has been removed from the treatment room. Practitioner will have bare arms up to the elbow and will wash hands and arms with soap and water for at least 20 seconds or use hand sanitiser gel. Practitioner to wear mask, gloves, and either plastic apron or change clothes between each patient. New pedal bins for deposing of waste between patients All toys and books removed from treatment room and waiting areas. Each patient will be offered 70% alcohol hand gel before and after treatments. The practitioner will open and close all doors for the patient.
Put in place distancing measures	Patients will be able to wait in their cars until the practitioner calls to say the room is ready for them. No other people will be in the hallway before or after treatments. The patient will come alone, and only bring what they need for the appointment. Patients asked to arrive close to their appointment times as to minimise contact with other patients Treatment times staggered so patients don’t come into contact with each other.
Providing remote/ telehealth consultations	Telephone consultations and advice available
	(Document last updated: 3/11/2020)

Table 2a. Protection of staff and patients before they visit, and when in the clinic. We have assessed the following areas of risk in our practice and put in place the following precautions to

	Description of risk	Mitigating action	When introduced
Pre-screening for risk before public/patients visit the clinic	Patients coming to the practice that have COVID 19 symptoms Patients in vulnerable category that need a treatment and therefore putting themselves at risk. Patients coming to the clinic and not being aware of the risk of coming. Patients coming to the clinic and putting other members of their household at risk or other people they are shielding.	• Triaging patients over the telephone in the first instance to see if advice can alleviate symptoms. Case history can be taken over the telephone to consider whether a face to face consultation is needed. • If face to face consultation is needed the screening for symptoms of COVID 19 • Screening for clinical vulnerable patients. Clinically vulnerable people are those who are: I .aged 70 or older (regardless of medical conditions) II. under 70 with an underlying health condition listed below (that is, anyone instructed to get a flu jab each year on medical grounds): III. chronic (long-term) mild to moderate respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis IV. chronic heart disease, such as heart failure V. chronic kidney disease VI. chronic liver disease, such as hepatitis VII. chronic neurological conditions, such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS), or cerebral palsy VIII. diabetes IX. a weakened immune system as the result of certain conditions, treatments like chemotherapy, or medicines such as steroid tablets X. being seriously overweight (a body mass index (BMI) of 40 or above) XI. pregnant women • Screening for additional respiratory symptoms or conditions e.g. asthma, hayfever etc • Screen to see if other members of the family have symptoms of COVID 19 or are in a high-risk category i.e. shielding. • Have they been in contact with someone with suspected/confirmed COVID 19 in last 14 days. • Communicate the risk of face to face consultation – document that the patient has been informed and that they are not experiencing symptoms. • Communicate process on arrival in clinic: patient needs to stay in their car until called, they will be given hand sanitising gel on arrival. Practitioner will open and close doors. *NB: All triage pre-screening information will be documented in the patient notes.*	11^th May 2020
Protecting members of staff		PPE to be worn by practitioner for treatments, detailed below in table 3	11^th May
Confirmed cases of COVID 19 amongst staff or patients?	A patient who has visited the clinic experiences symptoms of COVID 19 after their appointment	Should a patient advise me that they have symptoms of COVID-19 after visiting the clinic in line with government guidance.	11^th May
Travel to and from the clinic	Patients need to use public transport to the clinic Patient need a chaperone	This is a low risk for my clinic as most people can walk or come by car. If possible the chaperone will be asked to wait in their car, if they come by public transport then they can wait in the hallway or outside if the weather is nice.	11^th May
Entering and exiting the building Reception and common areas	Patients will not be able to social distance if they meet in the hallway between appointments. Patients will have to touch more surfaces if they must go into the bathroom to wash their hands before and after treatments	Patients will wait in their car until asked to come in. Patients will be asked to arrive close to their appointment time so that they are not kept waiting long. Patients will be given alcohol gel before and after treatment at the entrance door 11^th May	11^th May
Social/physical distancing measures in place	Patients may still meet outside	Appointment times will be staggered to allow for one person to leave before another arrives	3^rd April 2020
Face to face consultations (in-clinic room)	Minimise close contact during face to face consultations	Increase distance initially in treatment room. All treatment techniques are gentle and do not increase droplet production. Practitioner will look away from patient if its not necessary to look at them e.g. when not talking.	11^th May

Table 2b Hygiene measures We have assessed the following areas of risk in our practice and put in place the following heightened hygiene measures

	Description of risk	Mitigating action	When introduced
Increased sanitisation and cleaning	Areas that are difficult to clean between patients. Touch points are potential areas of cross contamination	Clinic decluttered, all linen, toys and books removed. Pillows and plinth covered in plastic. All hard surfaces wiped clean after each patient including door handles and chairs. Practitioner to open and close doors for patient	11^th May
Aeration of rooms	Droplets in the air from the patient contaminating room	Leave windows open during and after treatment.	11^th May
Staff hand hygiene measures	Cross contamination to patient and from patient.	Practitioner will wash hands and arms for at least 20 seconds before putting on gloves for treatment and again after.	3^rd April 2020

Table 3. Personal Protective Equipment: Detail here your policy for use and disposal of PPE

Clinicians will wear the following PPE	Single-use nitrile gloves and plastic aprons with each patient Fluid-resistant surgical masks (or higher grade)
When will PPE be replaced	When potentially contaminated, damaged, damp, or difficult to breathe through. At the end of a session (4 hours), or sooner if needed to be removed
Patients will be asked to wear the following PPE	Patients will be asked to wear face coverings as per government advice to wear face coverings in places where social distancing is difficult.
PPE disposal	New foot pedal bin for treatment room to dispose of PPE and paper on plinth. Double-plastic bagged and left for 72 hours before removal, keeping away from other household/garden waste, and then this can be placed in your normal waste for collection by your local authority. Cloths and cleaning wipes also bagged and disposed of with PPE

Table 4. Communicating with patients: Detail here how you will advise patients of measures that we have taken to ensure their safety and the policies that have been put in place in our clinic

Publishing your updated clinic policy	Available on website
Information on how you have adapted practice to mitigate risk	Available on Website
Pre-appointment screening calls	24 hours/morning before a scheduled appointment, practitioner will either call, text or email to confirm that they are well, their household is well and they have not been exposed to the virus
Information for patients displayed in the clinic	Notices displayed for hand washing, hand rubbing with gel. Notices informing patients that they cant be treated if they have symptoms of COVID 19
Other patient communications	Video on facebook page