Menopause Health Checks

The Work Wellness practitioner will assess your employee’s prior knowledge of:

• The cause of menopause, stages of menopause, menopause symptoms and their method of diagnosis.
• The possible longer-term health risks of:
  • Failing to adequately treat the cause of menopause
  • The treatments themselves.

The Work Wellness practitioner will seek to raise knowledge levels where this is important to your employee.

In summary, the menopause is caused by a reduction in the production of hormones such as oestrogen, progesterone and testosterone.  These hormones play an important role in protecting your employee’s:

• Cardiovascular health.  Menopause has been found to double the risk of cardiovascular disease in some women.  These lost hormones have been:
  • Allowing blood vessels to relax and widen so that blood can flow through them easily.
  • Reducing the levels of ‘bad’ cholesterol, thereby reducing the build-up of fatty plaque in your blood vessels.
• Musculoskeletal health:
  • These lost hormones have been helping the body to metabolise vitamins and minerals (e.g., calcium) which maintain bone mass.
• Mental health:
  • The reason(s) for the effects of menopause upon mental health have yet to be medically established.

Reliable health assessment can be affected by:

• Misunderstanding the questions being asked.
• Typically, overly optimistic recall of exercise and activity levels, diet, family health history and alcohol consumption (surveys find a tendency towards optimism).
• Typically, overly pessimistic disclosure of mood.

To ensure reliable health assessment, we encourage accurate disclosure of health risk factors by:

• Establishing trust and rapport.
• Careful positioning of questions and further explanation where needed.
• Listening without judgement and acknowledging your employee’s feelings.
• Helping the employee take a balanced view of their mood during the weeks leading up to the day of the assessment.

Your employee’s cardiovascular health risk is calculated using accurate measures of:

• Height / waist ratio (body shape) and height / weight ratio (Body Mass Index).
• Blood pressure, pulse and atrial fibrillation.
• Oxygen saturation level (less than 95% may indicate impaired lung function or circulation or iron deficiency).
• Good and bad cholesterol and glucose (involving a small skin prick).

All measurements are taken in compliance with clinical best practice guidelines using regularly calibrated medical equipment.  For example:

• The Cholesterol Analyser is calibrated every month by CPA (UK) Ltd (the accredited Laboratory Medicine department at Bolton NHS Foundation Trust).
• The blood pressure monitor is clinically validated by the British Hypertension Society.

The measurements obtained in Steps 2 and 3 are input into our expert system which provides objective and quantified health assessments.

Anxiety is calculated using the GAD-7 tool for assessment of the four most common anxiety disorders:

• Generalised Anxiety Disorder.
• Panic Disorder.
• Social Phobia.
• Post Traumatic Stress Disorder.

Depression is calculated using the PHQ-9 tool for assessment of the severity of depressive symptoms, not explained by substance use or another medical or psychiatric condition.

GAD-7 and PHQ-9 are accredited by the National Institute for Health and Care Excellence for measuring the presence and severity of Anxiety and Depression in primary care situations (e.g., during GP consultations and Mind Matters Assessments).

Cardiovascular Health Risk.  Calculated using the QRisk2 algorithm. It is NICE recommended for a full formal assessment of the risk of developing cardiovascular disease in the next 10 years.

Type 2 Diabetes Risk.  Calculated using an algorithm developed by Diabetes UK in collaboration with the University Hospitals of Leicester NHS Trust. It is NICE recommended for use by GPs and other primary healthcare professionals to predict the risk of developing Type 2 Diabetes within 10 years.

Alcohol Related Health Risk.  Calculated using the AUDIT-C algorithm (Alcohol Use Disorders Identification Test). AUDIT-C is sponsored by the World Health Organisation.

The importance of lifestyle in determining the severity of menopause symptoms cannot be underestimated.  Lifestyle factors can include:

• Healthy eating.
• Keeping active.
• Reducing alcohol consumption.
• Stopping smoking.
• Improving quality of sleep.

Two key clinical components of Menopause Health Checks encourage your employee to be open to discussing possible lifestyle changes:

1. The objectivity of the health risk calculators helps to de-personalise the assessment and externalise any sense that the employee is being “judged”.
2. We will have been:
   • Establishing trust and rapport.
   • Listening without judgement and acknowledging feelings.
   • Carefully listening for disclosure of underlying motivations, constraints and stressors.

This is a non-judgemental and motivational conversation supported by:

• Fact sheets which have evolved over hundreds of plain English, jargon free conversations. They cover subjects such as: the Menopause, Anxiety & Depression, Sleep, Diet, Alcohol, Smoking, Keeping Active, Walking, Blood Pressure, Diabetes, Cholesterol.
• Our unique expert system automatically recalculates health risk scores based upon positive lifestyle change intentions. In this way we can have a “what if” conversation, modifying lifestyle change intentions and testing their impact on health scores before gaining lasting commitment to a final set of achievable lifestyle changes.

Our Work Wellness practitioner will recommend links to additional self-help resources, sign-posting to local contacts and referrals to specialist practitioners if they are likely to help.

The Work Wellness practitioner can also help your employee to obtain the most effective menopause treatments from their GP by:

• Providing them with knowledge and advice so that they can have an informed conversation with their GP.  Demonstrating that they are  informed, are able to articulate the benefits that HRT is likely to provide, balanced with the associated risks, is likely to achieve a better outcome from their GP appointment.
• Help them to understand what they should reasonably expect from their GP, for example, by enquiring after a practitioner in the surgery who takes a special interest in menopause and / or asking for a double appointment.

Alternatively, the Work Wellness Practitioner can signpost your employee to alternative menopause specialists such as:

• Private GPs who specialise in menopause.
• A NHS menopause clinic (NHS and private accredited menopause specialists can be found on the British Menopause Society (BMS) website.

By the end of the Menopause Health Check we will have discussed a lot of information, answered many questions and your employee will be feeling positive and motivated.  We don’t want them to lose that feeling once they’re back at their workplace.

So they’ll be able to take away a personalised report containing 15 pages of; the measures we’ve taken, the lifestyle changes we’ve discussed, their impact on health risk scores, where to find self-help resources and referral routes to get further help.  That’s a lot of information to digest, so the report carefully structures it alongside plain English guidance.

The Menopause Health Check may not have identified any significant health risks.  Alternatively, as a result of lifestyle changes and specialist treatments your employee’s menopause symptoms and overall mental and physical health may have improved.

In any event, we encourage your employee to come back for a follow-up employee health assessment every year.  Our Expert System remembers them and re-presents their previous and latest information side by side, thereby freeing up time for a conversation about progress, any issues and next steps.