The impact of COVID-19 on a specialised menopause clinic: Changes in practice and women's experiences.

AIMS: The COVID-19 pandemic necessitated the rapid change in a dedicated multidisciplinary menopause clinic from in-person consultations to telehealth. The aim of this study was to explore the impact of COVID-19 on menopause service delivery and consumer experiences. METHODS: Two-part study involving the following. (i) Clinical audit conducted June-July 2019 (pre-COVID-19) and June-July 2020 (COVID-19) assessing practice and service delivery changes. Assessment outcomes included: patient demographics, cause of menopause, presence of menopause symptoms, appointment attendance, medical history, investigations and menopause treatments. (ii) A post-clinic online survey exploring the acceptability and experience of telehealth, once telehealth models of care had been routinely used in the menopause service (2021). RESULTS: Pre-COVID (n = 156) and COVID-19 (n = 150) clinic consultations were audited. Menopause care delivery changed significantly from 100% face-to-face consultations in 2019 to 95.4% telehealth consultations in 2020. In 2020, fewer women had investigations performed vs 2019 (P < 0.001), although use of menopausal therapies was similar (P < 0.05). Ninety-four women completed the online survey. Most women (70%) were satisfied with their telehealth consultation and perceived that the doctor effectively communicated with them (76%). Women preferred face-to-face consultations for their first menopause clinic visit (69%) and telehealth for review consultations (65%). The majority of women (62%) viewed the continuation of telehealth consultations as 'moderately' to 'extremely useful' post-pandemic. CONCLUSION: The COVID-19 pandemic caused significant changes to menopause service delivery. Telehealth was perceived as feasible and acceptable by women, supporting the continuation of a hybrid service delivery model incorporating telehealth and face-to-face consultation to meet the needs of women.

Premature ovarian insufficiency and infertility

[...]history * No significant medical history * No family history of early menopause or genetic disorders * Non-smoker * Two to three standard drinks per week * Taking a pregnancy vitamin supplement;no other medications or supplements * Goes to gym for 45 minutes twice per week;no other regular exercise * Up to date with cervical screening * Up to date with immunisations including rubella, varicella, influenza and COVID-19 Physical examination * Blood pressure 125/69 mmHg * Height 172 cm, weight 71 kg, body mass index 24 kg/m2 * No clinical hyperandrogenism, thyroid or pituitary disease * Urinary human chorionic gonadotropin (HCG) negative Susan's GP arranges the following initial investigations: * Serum HCG * Follicle-stimulating hormone (FSH) * Luteinising hormone (LH) * Oestradiol * Thyroid-stimulating hormone * Prolactin * Total testosterone, sex hormone binding globulin (SHBG) * Pelvic ultrasonography Investigation of secondary amenorrhoea The most common causes of secondary amenorrhoea are pregnancy, hypogonadotropic hypogonadism, polycystic ovary syndrome, hyperprolactinaemia and thyroid dysfunction. Results are as follows (laboratory reference ranges vary between laboratories): * HC G negative, FSH 51 IU/L (reference range follicular: 4-13 IU/L, mid-cycle: 5-22 IU/L, luteal: 2-8 IU/L, menopausal: 26-135 IU/L), LH 35 IU/L (reference range follicular: 2-10 IU/L, mid-cycle: 10-80 IU/L, luteal: 2-8 IU/L, menopausal: 8-59 IU/L), oestradiol <88 pmol/L (reference range follicular: <88-607 pmol/L, mid-cycle: 315-1828 pmol/L), luteal: 161-774 pmol/L, menopausal: <201 pmol/L), TSH normal, prolactin normal, testosterone low normal, SHBG normal * Pelvic ultrasound - normal uterine size, 'inactive ovaries' Testing of FSH is repeated four weeks later;the result is 45 IU/L. Risk factors for POI include: presence of specific genetic variants, positive family history, autoimmune disease, earlier menarche, chemotherapy, radiotherapy, pelvic surgery, smoking and being underweight.3 Adverse early life experiences, including childhood abuse and parental divorce, and low socioeconomic status are associated with lower age at menopause, though specific data for a relationship with POI are lacking.3 Observational studies have shown that POI is associated with an increased risk of osteoporosis, cardiovascular disease, depression, anxiety, diabetes mellitus, cognitive dysfunction, dementia and increased mortality. [...]with the current formulations of COCPs, although conception rates may be lower in the first three months post cessation of the COCP, they have normalised by 12 months.8 Taking the COCP may mask an underlying menstrual disorder. [...]women with four months of amenorrhoea post COCP cessation should be investigated for POI and not assumed to have post-pill amenorrhoea.