274677bf-b03d-42a8-bed4-18d64969940cPC Gynae Service Template v1.52022-07-11T13:00:00.8710016+01:00EMISWEBWESTWOOD, Jonathan (Mr)AdministrationfalsefalseAdministrationfalse78cb9304-67a1-4db5-8820-286537048e0dfalsefalse{\rtf1\ansi\ansicpg1252\deff0\nouicompat\deflang2057{\fonttbl{\f0\fswiss\fprq2\fcharset0 Tahoma;}{\f1\fnil\fcharset0 Tahoma;}}
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\pard\widctlpar\cf1\ul\b\f0\fs18 Primary Care Gynae Service\par
\ulnone\b0\par
This template has been designed to be only used in the PCG service and you \ul\b must\ulnone\b0 complete the fields below before completing the template.\par
\par
This is to differentiate between PCGS and services such as public health initiatives within the Coventry and Warwickshire geography. \par
\pard\cf0\f1\par
}
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falsefalseComments (for specific procedures use the pages to the left)falsee92e8871-41ca-4bd4-99f3-f9cc6a05d87afalsefalse0595e833-2737-4c4f-907f-15370ce5e073falsefalse{\rtf1\ansi\ansicpg1252\deff0\nouicompat\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
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falsefalseChaperonefalseabb4f884-08f6-43b4-a069-4874efd05c88falsefalseSNOMED_CONCEPTSNOMED_CONCEPTSNOMED_CONCEPTSNOMED_CONCEPTfalsetrueAVB ManagementfalsefalseAVB Managementfalseec428a3a-0569-42ec-96b1-30d69284c373falsefalsetruetrueMirenaCOCNEXPLANONPOPDEPOMEFENAMIC ACIDTRANEXAMIC ACIDAwait InvestigationsRefer to Secondary CareOtherAVB ReviewfalsefalseAVB Reviewfalsed9d756e1-acbe-43f5-9265-6f199d578005falsefalsePCGS - Nexplanon Ins95506330-a413-4432-9d59-11b631498b341Nexplanon_Insertionda4e5163-da06-4c41-a046-72a234677d3bfalsefalseNexplanon Insfalsecff656bd-2713-4065-930f-247b2334eee5falsefalseSNOMED_CONCEPTfalsetrue7c3fd305-5e7d-41cd-800e-5313a27f7067falsefalseSNOMED_CONCEPTfalsefalsefa1b6016-91b7-4bb4-92cb-e653a034784dfalsefalsefalsefalse3ee82025-02cf-4ae6-9348-a6e0d5b22af6falsefalsefalsefalseeb54340b-5be9-487f-8926-41ba2ecdf578falsefalsefalsefalsed1e52f6b-8476-47ef-b1c0-2afe30cbcfa0falsefalsefalsefalsef2e7346a-0354-476f-8893-dc76336265b3falsefalsefalsefalsed1781eab-cabb-4117-90e6-dab61b60efb8falsefalsefalsefalseafa220d9-042f-4e42-8c8e-277924f33129falsefalsefalsefalseLeft ArmRight Arm383c4b93-28f1-465e-ba83-e81a6ae191aetruefalseSNOMED_CONCEPTfalsetrued49995f9-1d4d-4216-8d79-0099ba323d41falsefalsefalsefalsePCGS - Nexplanon Rem95d2c414-515e-4425-a94e-23df32928b491Nexplanon_RemovalfalsefalseNexplanon Removalfalse55944c37-e728-4256-a20f-4eb6d66f97a5falsefalseSNOMED_CONCEPTfalsefalsef8b55687-4568-4933-94bd-cfc4360f4a46falsefalsefalsefalseb820ab94-f497-4ef6-960d-f9b90381e71efalsefalseSNOMED_CONCEPTtruefalsecd893303-6c02-424d-9bd1-8faff9e3368cfalsefalsefalsetrue2915ec78-d808-475f-9edf-8dbea963a8e8falsefalsefalsefalse7adbeace-9ce6-437c-87f2-bdced0fdd408falsefalsefalsefalse54df92c4-a413-4eec-9cd8-ae10fc5adf10falsefalsefalsefalsePCGS - IUS/IUD Insertion9b09c051-b231-45c1-a31a-6b54e112439a1IUD/IUS Insertion1621f797-c471-4c54-939a-32cedf801fa2falsefalseIUS/IUD Insertionfalsedeabdf9d-191d-412a-90ad-62e349056047falsefalseSNOMED_CONCEPTfalsetrue26aa41cf-e517-4101-b9c6-e266add831affalsefalsefalsefalsedfdc9f9a-7851-44c5-a16c-b381ca3e7fe6falsefalseSNOMED_CONCEPTfalsefalse91459b03-ecb2-4df6-a0f7-388c422eb4eefalsefalsefalsetrueMIRENAJAYDESSKYLEENAOTHER12adb619-7cce-494c-aae4-29422ba0d8aefalsefalsefalsetrue098d91af-707c-4818-af2c-c1c8cd31b537falsefalsefalsetrue0facb675-ddd3-474f-8a50-10a383f8c58ffalsefalseYesNofalse622b7d59-3810-4c5c-84d4-41fe64d531c7falsefalsefalsefalseCervical block LA usedInstillagel LA usedXylocaine LA spray usedNo local anaesthetic used113f1162-de2d-4ff1-b7ad-5b8b6df1aff1falsefalsefalsefalse4b42477b-0f1f-4bdf-8ed4-461317d7b88cfalsefalsefalsefalse3cb2895c-12b0-4229-890b-684c2cfcd1f0falsefalsefalsetrue58897601-8ae7-4abb-92df-e14fc7c6036cfalsefalsefalsefalsedff41948-15e1-45a4-b11d-abdfda43daa0falsefalsefalsefalsef628c945-afb8-4dbc-9dfb-c5fddea56858falsefalsefalsefalse13461af0-d8b9-48b8-a9eb-bfd52ef5d777falsefalseSNOMED_CONCEPTfalsetrueeae7b7f6-fafb-4e5f-80c1-083bbef2380dfalsefalseSNOMED_CONCEPTfalsefalse7b50b655-47c1-45cf-b87e-994f30f931d7falsefalsefalsefalsea1404776-0244-4a04-aa1a-b0e0763fd6bcfalsefalsefalsefalsee1669cc6-d173-4a40-9a59-a73e2c318550truefalseSNOMED_CONCEPTfalsetrue7cf2cb6f-21e8-482c-b533-49008465d692falsefalsefalsetruePCGS AVB History/Conditionc1097c4e-c04a-4e27-ae58-428f4d0040221AVB History/Condition9a8a5745-8664-461d-b4d6-785582143e57falsefalseHistoryfalse4adcf850-b4b4-4ae9-a069-a1d54611d865falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18 Please use the following fields to document the nature of the bleeding:\par
}
65f743f1-8798-4a92-95f8-2338a1b7e95dtruefalsefalsetrue8e027d25-35f0-4fa5-bcc1-8291051c43d1falsefalseSNOMED_CONCEPTfalsetrue3f39737d-1f13-40e8-856d-6f182ad568fbfalsefalseSNOMED_CONCEPTSNOMED_CONCEPTSNOMED_CONCEPTSNOMED_CONCEPTSNOMED_CONCEPTtruetrue12dafec4-6b0d-401f-8621-9446328d986efalsefalseSNOMED_CONCEPTfalsetruea8d8d8ac-d7b8-4407-b1ec-37771faf2d15falsefalsetruefalseIUS MirenaIUS JaydessIUS KyleenaIUD 5 yearsIUD 10 yearsNexplanon 3 yearsDepot ProveraCOC - pillsCOC - patchCOC - NuvaringPOP - DesogestrelPOP OtherNone5e1fe84c-973f-45e1-b14e-5fa83cb50fd1falsefalse223f93cc-e7e4-4f5a-97f3-793e38615ab2falsefalseebbb37a6-757a-4eba-8b5c-d1efe7b96cd0falsefalsetruefalseHas already tried Mefenamic AcidHas already tried Tranexamic AcidHas already tried MirenaHas already tried COCHas already tried POP4982829b-d83c-489c-b2ff-76de3281548ffalsefalsefalsetruedetails?e8fb9e7b-0c82-44e2-93e1-b19851af3138falsefalseSNOMED_CONCEPTfalsetrued2583ba4-e847-483c-973a-571d9f570e97falsefalseSexual historyfalsea0113b2f-0e24-43da-8f99-e95173633300falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18 Please use the following to record any relevant sexual history:\par
}
296455b3-869a-40bb-9ec8-80bb905600bbfalsefalsefalsetrue5dc2fecc-d054-4b4d-9a43-12d74451aff5falsefalsefalsetruea695da9e-ebd5-4e2e-9c7d-9c632e1f0f12truefalseSNOMED_CONCEPTfalsetrue5d0c6e73-0185-43c2-a8da-0b3614da1de8falsefalseAny further historyfalse96df2273-80d9-4e68-92b2-450057baeacbfalsefalseZAP Cervical Smears (QOF)5bf30a96-12f3-410e-9285-dc8d284a7ebf2958197f5-2926-4869-8cb0-4fe55853c2c3falsefalseCervical Cytology (QOF)false16006177-7a44-472a-b28d-1b43abfef08atruefalseSNOMED_CONCEPTSNOMED_CONCEPTfalsetrue265b2b91-fa41-48a8-b444-4e11ae94dce3truefalseSNOMED_CONCEPTSNOMED_CONCEPTfalsetrue159abdbf-3ca4-4827-be04-c4661820be79truefalseSNOMED_CONCEPTSNOMED_CONCEPTSNOMED_CONCEPTSNOMED_CONCEPTfalsetrue421ccf9d-2e4d-4de1-90b4-c2c14b5831f3truefalseSNOMED_CONCEPTSNOMED_CONCEPTSNOMED_CONCEPTSNOMED_CONCEPTtruetruePCGS AVB Investigationa49e558c-2d7a-40d6-86dc-c4996c2401f11AVB InvestigationsfalsefalseInvestigationsfalse4decfbe6-ead7-4c7d-ac0f-d844a05aa86ffalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}{\f1\fnil\fcharset2 Symbol;}}
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\viewkind4\uc1\pard\f0\fs18 A Full Blood Count is recommended for women with heavy menstrual bleeding.\par
\par
\cf1 Testing for coagulation disorders (for example, von Willebrand's disease) should be considered for women who:\par
\par
\pard{\pntext\f1\'B7\tab}{\*\pn\pnlvlblt\pnf1\pnindent0{\pntxtb\'B7}}\fi-150\li450 have had HMB since their periods started and\par
\pard{\pntext\f1\'B7\tab}{\*\pn\pnlvlblt\pnf1\pnindent0{\pntxtb\'B7}}\fi-150\li450\tx220\tx720 have a personal or family history suggesting a coagulation disorder. (NICE 2007)\cf0\par
\pard\par
}
7ce34a9c-5257-4698-8345-5cb3bfe93a10falsefalsefalsetrue329d8402-aa6e-4dcc-9a16-6edff238c608falsefalse{\rtf1\fbidis\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fswiss\fprq2\fcharset0 Tahoma;}{\f1\fswiss\fprq2\fcharset0 Calibri;}{\f2\fnil\fcharset0 Tahoma;}{\f3\fnil\fcharset2 Symbol;}}
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\viewkind4\uc1\pard\ltrpar\fi-11\tx220\tx720\cf1\lang1033\f0\fs18 You may wish to consider a routine transvaginal ultrasound scan if history or examination suggest a structural or histological problem, (eg intermenstrual or postcoital bleeding, pelvic pain and/or pressure \par
\pard\ltrpar symptoms)\cf0\lang2057\f1\fs24\par
\pard\ltrpar\fi-720\li720\tx220\tx720\cf1\f2\fs18\par
or if:\par
\par
\pard{\pntext\f3\'B7\tab}{\*\pn\pnlvlblt\pnf3\pnindent0{\pntxtb\'B7}}\ltrpar\fi-150\li450\tx940\tx1440 The uterus is palpable abdominally.\par
{\pntext\f3\'B7\tab}There is a pelvic mass on bimanual examination.\par
\pard{\pntext\f3\'B7\tab}{\*\pn\pnlvlblt\pnf3\pnindent0{\pntxtb\'B7}}\ltrpar\fi-150\li450 Medical treatment has not worked.\cf0\par
}
1dd590b9-da16-49cd-83b0-8d3047711da9falsefalsefalsetrue9e1a6c8f-0054-4b12-9f45-e89a4dd7b592falsefalseSNOMED_CONCEPTSNOMED_CONCEPTSNOMED_CONCEPTtruefalse61a17c05-69e4-4dcf-8cf1-89f77d13f075truefalseSNOMED_CONCEPTfalsetrueb04f01a6-dcd3-4ff6-872d-f2807f594a66truefalseSNOMED_CONCEPTfalsetruePCGS AVB Management8ca63222-8995-4d72-b369-cb97bb3341241AVB Management GuidelinesfalsefalseClinical Knowledge Summariesfalse42a5bac9-8711-4bd1-bbb6-9092a567d7e9falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18 CKS offer guidance on this topic that can be viewed from the following link:\par
}
039145de-6ab0-457f-9619-6a67d4ac10befalsefalseCKS Menorrhagiahttp://qmasters.info/menorrhagiaCKSfalsefalseNICE guidancefalsebd8e43d1-ab3e-49ba-9e0d-94a1bc910a0afalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18 Please use the link below to access the NICE guideline for Heavy Menstrual Bleeding:\par
}
b63168cb-e2fc-4495-8805-eb4e9f03d7b4falsefalseNICE Guidance - Heavy Menstrual Bleedinghttp://qmasters.info/menorrhagiaNICEPCGS AVB Referralf9ca56e9-3263-43ca-994d-8dc82e6dfb751AVB ReferralsfalsefalseReferral informationfalse989d7a52-c243-47db-9a30-28b817c9ce26falsefalse{\rtf1\fbidis\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}{\f1\fswiss\fprq2\fcharset0 Tahoma;}{\f2\fswiss\fprq2\fcharset0 Calibri;}{\f3\fnil\fcharset2 Symbol;}}
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\viewkind4\uc1\pard\ltrpar\f0\fs18 Where you feel it is clinically appropriate to refer the patient, please refer in line with your local policy.\par
\par
\cf1 You may wish to consider referral when:\par
\par
\pard{\pntext\f3\'B7\tab}{\*\pn\pnlvlblt\pnf3\pnindent0{\pntxtb\'B7}}\ltrpar\fi-150\li450\tx940\tx1440\cf2\lang1033\f1 The patient has ascites and/or a pelvic or abdominal mass (which is not obviously due to uterine fibroids). \b\f0 (URGENT or 2ww)\b0\f1\par
{\pntext\f3\'B7\tab}The patient has a pelvic mass associated with any other featuresof cancer (such as unexplained bleeding, or weight loss). \b\f0 (URGENT or 2ww)\b0\f1\par
\pard\ltrpar\li300\tx940\tx1440\par
\pard\ltrpar\tx220\tx720 Also you may wish to refer if:\par
\par
\pard{\pntext\f3\'B7\tab}{\*\pn\pnlvlblt\pnf3\pnindent0{\pntxtb\'B7}}\ltrpar\fi-150\li450\tx940\tx1440 Menorrhagia has not improved with primary care treatments.\cf0\lang2057\f2\fs24\par
\cf2\lang1033\f1\fs18{\pntext\f3\'B7\tab}There are other symptoms from eg large fibroids (for example dyspareunia, pelvic pain or discomfort, constipation, or urinary symptoms).\cf0\lang2057\f2\fs24\par
\cf2\lang1033\f1\fs18{\pntext\f3\'B7\tab}She wishes to consider surgery rather than continue with medical treatment. \cf0\lang2057\f2\fs24\par
\cf2\lang1033\f1\fs18{\pntext\f3\'B7\tab}Iron deficiency anaemia is not responding to treatment, and other causes have been excluded or treated. \cf0\lang2057\f2\fs24\par
\pard\ltrpar\cf1\f0\fs18\par
\par
\cf0\par
}
PCGS AVB Resources6993afd6-7572-43a1-bff9-89e8d72b58261AVB ResourcesfalsefalsePatient Resourcesfalsed37aa555-f4e6-4da8-8014-e8680cf41175falsefalseMenorrhagia - patient.infohttps://qmasters.info/menorrhagia-patient-infoe71347e3-0dc6-40c6-ac1c-5d1db6938298falsefalseHeavy Periods - NHS Choiceshttps://qmasters.info/heavy-periods-NHS-choicesfalsefalseRecord here that you have given a patient information leafletfalse9e369062-b7aa-4783-8321-b585013067a6falsefalseSCT_READV2falsetruePCGS Meno/HRT Conditionsfc11f08a-2c08-4150-b122-8e0d2289082a1Meno/HRT ConditionfalsefalseMenopausefalse383b3eca-5934-4178-8da7-b1823e802bf5falsefalse{\rtf1\ansi\ansicpg1252\deff0\nouicompat\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}{\f1\fnil\fcharset2 Symbol;}}
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\pard\cf1\f0\fs18 The perimenopause:\par
\par
\pard{\pntext\f1\'B7\tab}{\*\pn\pnlvlblt\pnf1\pnindent0{\pntxtb\'B7}}\fi-150\li450 The period before the menopause when the endocrinological, biological, and clinical features of approaching the menopause commence.\par
{\pntext\f1\'B7\tab}Characterised by irregular cycles of ovulation and menstruation. Usually begins with a change to the menstrual pattern. Cycle length may shorten to 2-3 weeks or lengthen to many months. The amount of menstrual blood loss may change (most commonly increases slightly).\par
{\pntext\f1\'B7\tab}Diagnosed without lab tests in otherwise healthy women aged over 45 years with menopausal symptoms including vasomotor symptoms and irregular periods. \par
{\pntext\f1\'B7\tab}Vasomotor symptoms (hot flushes and night sweats) are the most commonly reported menopausal symptoms. Mean duration is 7 years. \par
{\pntext\f1\'B7\tab}It ends 12 months after the last menstrual period.\cf0\par
}
c15121aa-48b0-446a-ae8f-3442b0bcd5c7falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18 Please see the below link for when to suspect the menopause:\par
}
850e151e-6354-4fd0-a4c9-8f3cad68803ffalsefalseNICE CKS when to suspect the menopausehttps://ardens.live/NICE-CKS-when-to-suspect-the-menopausePCGS Meno/HRT History760c1441-8519-42d8-8ba5-416a65fc0d9c1Meno/HRT Historye6e13102-3ce0-4379-9d63-19c30e7024d3falsefalseHistoryHistorytrue0cacc198-9b99-44bf-8ad0-5fc26cb27091falsefalseSNOMED_CONCEPTSNOMED_CONCEPTfalsetrue2fbc59e5-4c56-48fb-960c-67db4fcf8567falsefalsefalsetruee8434cac-b5ca-4507-b94b-a1fdc2039220truefalsefalsetrue2810b954-7f08-44d7-a6bb-57880c82e13afalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18\par
\b Please tick as many symptoms as required:\b0\par
}
c7c9c2fe-ffb0-491c-a91b-5ad3080add25falsefalseSNOMED_CONCEPTSNOMED_CONCEPTSNOMED_CONCEPTSNOMED_CONCEPTSNOMED_CONCEPTSNOMED_CONCEPTSNOMED_CONCEPTSNOMED_CONCEPTSNOMED_CONCEPTSNOMED_CONCEPTSNOMED_CONCEPTSNOMED_CONCEPTSNOMED_CONCEPTSNOMED_CONCEPTSNOMED_CONCEPTSNOMED_CONCEPTtruetrue0e173528-e553-4847-8823-027572e2085afalsefalsefalsetrueAt risk of pregnancyNot at risk of pregnancy74f2f3aa-c2b7-461b-ab04-7d956c7ec55cfalsefalsefalsetrueNo recent change in sexual partnerRecent change in sexual partnerf226685b-3087-4c62-99d3-ec980c4837f9falsefalsefalsetrueConcerns about vaginal bleedingNo concerns about vaginal bleedinga9d836d1-ebee-4067-b109-c6496a9291f3falsefalse942c9e91-867b-4603-824b-547da8d26e27falsefalsede338cac-7e65-4a8b-a3e9-4a229239ec2ffalsefalsebd8c7b9d-9b44-492f-843a-c28923bb01edfalsefalseIf contemplating HRT, additional history itemsIf contemplating HRT, additional history itemstruec1b39a50-b955-4752-b049-a9081e08238afalsefalseSCT_READV2SCT_READV2falsetrue18e6e7ed-9df2-469c-975b-172675a9814afalsefalseSCT_READV2SCT_READV2SCT_READV2falsetrue6967fe7d-717f-4313-8598-db83d5ecdaabfalsefalseSNOMED_CONCEPTSNOMED_CONCEPTSNOMED_CONCEPTfalsetruef5ddf6db-e2ee-46c8-b424-342be2a6e626falsefalseSNOMED_CONCEPTSNOMED_CONCEPTSNOMED_CONCEPTfalsetruea29dadc8-13db-4e7e-9916-e164ce18d3c2falsefalseSCT_READV2SCT_READV2SCT_READV2falsetrue1d203067-6804-46ac-9116-20619e6880bbfalsefalsee6c9df94-5f16-4570-afcc-de4836401fddfalsefalseLiver disease, malabsorption, thyroid problems, diabetes (non oral forms of HRT are preferred)PCGS Meno/HRT Lifestyle9baaeea2-fb9f-444d-8c6d-254aede08cac1Meno/HRT LifestylefalsefalseSMOK002 Smoking statusSmokingtrue619628d7-3d27-47f5-9686-ab0e6c0f0a57falsefalse{\rtf1\fbidis\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fswiss\fprq2\fcharset0 Tahoma;}{\f1\fnil\fprq2\fcharset2 Wingdings;}{\f2\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red186\green20\blue25;\red0\green197\blue5;}
\viewkind4\uc1\pard\ltrpar\nowidctlpar\cf1\f0\fs18 Smoking status should be recorded annually (25 points)\par
\par
\pard\ltrpar Please be aware that in the absence of a quantitative value, the EMIS QRISK calculator will assume the patient who smokes is a 'light smoker'.\cf2\b\f1\fs28\par
\par
)\cf0\f2\fs18 The remainder of this lifestyle page can also be carried out remotely:\par
}
b11f8dff-1f63-44ea-9f94-8d738786e7fbfalsefalseSCT_READV2falsefalse61086ecf-be11-4bef-bf23-2c795c2eefc0falsefalseSCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2falsefalsed01b0038-cd58-4e3a-b30f-7c46135a94e0falsefalseSCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2falsefalse2a8d9478-b35d-4dd7-999e-b3ad4620459afalsefalse{\rtf1\fbidis\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fswiss\fprq2\fcharset0 Tahoma;}{\f1\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red0\green0\blue0;}
\viewkind4\uc1\pard\ltrpar\nowidctlpar\cf1\f0\fs18 The codes below can be added, but please note that they do \b NOT\b0 count for QOF\cf0\f1\par
}
14fb9dde-a461-4e56-a25f-c52d0df3b988falsefalseSCT_READV2SCT_READV2SCT_READV2SCT_READV2SCT_READV2falsefalse7dbc72f9-1418-4edf-b38c-665a7ec45aeafalsefalseSCT_READV2falsefalsefalsefalseLifestyle adviceLifestyle advicetrue451101f3-6588-44f1-a487-599ee3895d0dfalsefalseSCT_READV2falsetrue2e60936c-3a18-46c7-a3ca-6b8c9fa3b35efalsefalseSCT_READV2falsetrueec420c8e-9a45-4ac2-b115-12387fd9cc00falsefalseSCT_READV2falsefalsefalsefalseNICE guidancefalse0b34c677-66da-41ad-8616-d3b5383730e0falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fswiss\fprq2\fcharset0 Tahoma;}{\f1\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red0\green0\blue0;}
\viewkind4\uc1\pard\nowidctlpar\cf1\f0\fs18 Please use the following link to access the NICE guidance for obesity\cf0\f1\par
}
5e5f511a-65ca-4c6c-bfe0-c2364ddb17aafalsefalseNICE guidance - obesityhttps://qmasters.info/NICE-obesity0586f9e9-b407-49a9-af95-534f6506f988falsefalse{\rtf1\fbidis\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fswiss\fprq2\fcharset0 Tahoma;}{\f1\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red0\green0\blue0;}
\viewkind4\uc1\pard\ltrpar\nowidctlpar\cf1\f0\fs18 Please use the following link to access NICE guidance for smoking cessation\cf0\f1\par
}
b3a1276d-5e96-478a-a79f-31534a845bbffalsefalseNICE guidance - smoking cessationhttps://qmasters.info/NICE-smoking-cessationCommunity - Alcohol Intakea5a4f7f2-cb71-4c99-9b1f-4c619576826e244fe10bc-fc37-45d5-92af-5b7c7aa42358falsefalseAlcohol Intakefalsee1be7bb8-f58f-44c8-b792-e9cf743ad150falsefalsefalsefalse000aadad-5c8b-4522-93e8-2cada427dbf7falsefalsefalsefalsePCGS Meno/HRT Examinationc09fa0ae-a153-43ed-b10b-0ac1973f96201Meno/HRT ExaminationfalsefalseOB002 ObesityOB002 Obesitytrue1a225207-79f0-4544-b734-ef47905c2d61falsefalseSCT_READV2falsefalsec5f8ccba-ba5c-4384-99ee-e63ab9931b6cfalsefalseSCT_READV2falsefalse05389f92-c2f1-476f-88da-ccb7c98c2e47falsefalseBody Mass IndexfalseSCT_READV2falsefalsefalseBlood pressureBlood pressuretrued36fe597-20eb-4eda-9f8c-00d43143764efalsefalsefalsefalsedd611877-9937-4284-b4d3-bf793331c468falsefalseO/E - blood pressure readingfalsefalsefalsefalseExaminations and InvestigationsExaminations and Investigationstrue689e16be-cd2b-498b-9686-83fe4d99b538falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18 See link to CKS guidelines for guidance regarding when differential diagnoses and when further examinations and investigations are required before starting HRT\par
}
195f5528-d991-4472-8ffe-c19feebab185falsefalseSNOMED_CONCEPTfalsetrueeed1fee5-9fd3-40cf-8896-afa9c8b5c444falsefalse50d399a9-2964-4cc1-bf26-4b49cef86e1ffalsefalseCKS Menopause Differential Diagnosishttps://rebrand.ly/CKSMenopauseDifferentialDiagnosisa0ed3d05-3422-428e-98a5-c9bd383f91d4falsefalseCKS Menopause examinations and investigations https://rebrand.ly/CKSMenopauseInvestigationPCGS Meno/HRT Investigationsb8327c3d-e84a-4bc6-afe2-f6c156d99f731Meno/HRT InvestigationsfalsefalseDiagnosing menopauseDiagnosing menopausetrue48973100-8181-4131-812b-a3993577189cfalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}{\f1\fnil\fcharset2 Symbol;}}
{\colortbl ;\red0\green0\blue0;}
\viewkind4\uc1\pard\cf1\b\f0\fs18 It is generally possible to confirm the menopause WITHOUT lab tests in otherwise healthy women aged over 45 years with menopausal symptoms\b0\line\par
\pard{\pntext\f1\'B7\tab}{\*\pn\pnlvlblt\pnf1\pnindent0{\pntxtb\'B7}}\fi-150\li450 if the woman has not had a period for > 12 months \cf0\par
\cf1{\pntext\f1\'B7\tab}based on symptoms in women without a uterus\cf0\par
}
b71cd353-b04e-4bf0-8244-52a79065a06cfalsefalseSNOMED_CONCEPTfalsetruefalsefalseDiagnosing premature menopauseDiagnosing premature menopausetrue9f2b4e73-ec77-4480-bf0b-9d1a123037b7falsefalse{\rtf1\fbidis\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fprq2\fcharset2 Wingdings;}{\f1\fnil\fcharset0 Tahoma;}{\f2\fnil\fcharset2 Symbol;}}
{\colortbl ;\red186\green20\blue25;}
\viewkind4\uc1\pard\ltrpar\cf1\b\f0\fs28 )\cf0\f1\fs18 The diagnosis of premature menopause should take into account the women's clinical history (for example previous medical or surgical treatment) and family history. \b0\par
\par
\b Diagnose premature menopause in women aged <40 years with \b0\line\par
\pard{\pntext\f2\'B7\tab}{\*\pn\pnlvlblt\pnf2\pnindent0{\pntxtb\'B7}}\ltrpar\fi-150\li450 Menopausal symptoms including no or infrequent periods (taking into account whether the woman has a uterus)\line\pard\ltrpar\li300\line AND\line\pard{\pntext\f2\'B7\tab}{\*\pn\pnlvlblt\pnf2\pnindent0{\pntxtb\'B7}}\ltrpar\fi-150\li450\par
{\pntext\f2\'B7\tab}Elevated FSH on 2 blood samples taken 4-6 weeks apart (Do not use serum FSH to confirm menopause if using combined oestrogen and progestogen contraception or high-dose progestogen, as the diagnostic accuracy may be confounded by these treatments)\b\line\b0\par
}
b88c197b-85c4-4e5d-8488-e568ef132601falsefalsefalsetruefalsefalseFurther investigationsFurther investigationstruePCGS Meno Mangementd61b23e9-2111-42d0-92f4-69ee5f3fb5501Menopause managementfalsefalseInformation and adviceInformation and advicetrue5a8fe041-41be-49d1-b876-b3334ca9cfcdfalsefalsefalsetruecdad4809-d33d-41ab-8e0d-50e3e088c69afalsefalsefalsetrue6b52c7e5-59f8-41b0-9ea3-2ff6acb3134efalsefalsefalsetruefb2c5a47-b0b2-46e3-9942-d4076bbd81affalsefalsefalsetrue523ebf83-9b2c-4d30-a0db-d99b14c67d98falsefalsefalsetrue4afb3d97-7104-486b-b718-ffd46ba16e10falsefalseSCT_READV2falsefalsefalsefalseScreeningfalse5ce29778-1944-4366-863a-d88aa1cc0d26falsefalsefalsetrued93253a0-96d6-4fbe-bb0d-412ca5ca9613falsefalsefalsetrue39918997-7ef7-40ef-b136-625c13cb5900falsefalsefalsetruefalsefalseNICE Guidancefalse3d3a4bda-810a-4fa4-a2c8-db1a0cd87850falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18 Please use the following link to access the NICE guidance for menopause:\par
}
69b62b4c-54a6-4ff7-9518-5404c2248b95falsefalseNICE Guidance - Menopausehttp://qmasters.info/NICEmenopausePCGS HRT Initiationad048bb8-a50c-4b9f-8b94-237a4847392e1HRT InitiationfalsefalseAssess need for progestogen componentfalse3a244d7d-5c39-44c6-bb37-6eaa15324200falsefalsefalsetruePatient has uterusPatient has had hysterectomy (check coded correctly in record and record reason)4b228c6f-6a10-4795-b628-d1d81ba218cftruefalsefalsetrueNo 52mg LNG IUS in situ52mg LNG IUS fitted within the last 5 years52mg LNG IUS in situ but been present for >5 yearsfalsefalseRisks and contraindicationsfalse6cb62396-410c-4a9d-8fae-18a102179a26falsefalseContraindications include VTE, endometrial cancer (reduced by progestogen), breast cancer and ovarian cancer. CHD risk is also increased in women who start combined HRT> 10 years after menopause.{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\b\f0\fs18 Please document HRT risk and contraindication discussion below (hover to view current BNF risks)\par
\par
}
55203348-15d5-455e-9ac9-8a44b8260e80falsefalseHRT risks include VTE, endometrial cancer (reduced by progestogen), breast cancer and ovarian cancer. CHD risk is also increased in women who start combined HRT 10 years after menopause. (BNF)falsetruef7f5167a-f7f0-4594-b1ef-674f117d1e33falsefalsefalsetruef8d04478-75dd-488a-939b-03e001d57f56falsefalseSNOMED_CONCEPTfalsetruecf933603-e65f-4fcc-89e9-4b9c7bb9e18efalsefalseBNF HRT contraindicationshttps://ardens.live/HRT-contraindicationsfalsefalseChoice of HRTfalse60a5c254-4a04-4d24-b46e-56008796de5ffalsefalseSNOMED_CONCEPTSNOMED_CONCEPTSNOMED_CONCEPTtruetrue1d3ce7a8-87d2-4db5-8aae-3489c48870b0falsefalseSNOMED_CONCEPTSNOMED_CONCEPTfalsefalse49b28371-0466-4081-bd10-e1c49d03aef0falsefalsetruetrueOestrogen only transdermal (gel/patch) with progestogen or micronised progesteroneOestrogen only transdermal (gel/patch)Combined transdermal (gel/patch)Oestrogen patch/gel with IUS progestogen (Mirena)Oestrogen only oralCombined oralVaginal oestrogen600cd049-e010-40b4-89f1-fdd1f2c34cebfalsefalse6e254f37-7364-4eb9-8ae7-c56aa826ebbbfalsefalsePCWHF menopause remote consultationhttps://ardens.live/Menopause-remote-consultationfalsefalseFollow upfalse2be17e87-2586-4758-bbb8-1e1413e85510falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18 Advice patient when HRT follow up is due:\par
}
c7ce4154-e4e1-4700-a26d-8ff13a879229truefalseSNOMED_CONCEPTfalsefalsePCGS HRT Review524fbead-15eb-4a85-b8eb-a238a42559901HRT ReviewfalsefalseReview of HRTfalse593edbe1-1261-4b41-b3a9-5544ef18d795falsefalseSCT_READV2falsetruefalsefalseReviewReview / Follow upfalse21aac1d5-311f-4f9c-9c41-d5cd746469e0falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18 NICE recommend reviewing a woman with menopausal symptoms after 3 months, then annually thereafter unless there are clinical indications for an earlier review.\par
\par
Cyclical/sequential HRT regimens can be switched to continuous combined regimens after 1 year of cyclical HRT if the woman is considered to be postmenopausal, or if she is >54y.\par
\par
\i NICE, 2019\i0\par
\par
}
d7f26336-5045-4aa5-9575-bd1d78899353falsefalseSNOMED_CONCEPTfalsefalsedef18370-7963-40c2-9970-4e1c0c123480falsefalsefalsetruec219c5ef-f8cd-4d53-a017-8a61928861a4falsefalsea96f89be-20f1-4a48-a7d3-6ca4de11dd32falsefalse2e2a6b8f-e573-4a42-9b01-dd22eb7e68bafalsefalse0726f0e0-832e-4906-abb6-159da271f9b4falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\b\f0\fs18\par
If in doubt, offer contraception until aged 55:\par
}
b58c851c-2e69-4c2f-a5b0-b335809d4bbffalsefalsefalsetrueCurrent need for contraceptionNo need for contraception87f74a08-72b7-4e35-91bb-1458344e628afalsefalsefalsetrueNo side effects from HRTSide effects from HRT present3f73a88e-beb3-4b4b-be69-13eadb17a217falsefalsefalsetrueNo concerns about vaginal bleedingConcerns about vaginal bleeding68fd2b5e-d2ec-4c03-a34e-405749d3b6a6falsefalsefalsetrueTestosterone addition not appropriateTestosterone may add benefit8253df02-4328-4fcf-beca-103a69ee38ebfalsefalsefalsetruefalsefalseReview need for progestogen componentfalse9b28ff60-6f42-43b6-ad5e-99f9e6154e52falsefalsefalsetruePatient has uterusPatient has had hysterectomy (check coded correctly in record and record reason)cdbfdc9f-b0c5-45a9-90d3-e6ac38fc2c19truefalsefalsetrueNo 52mg LNG IUS in situ52mg LNG IUS fitted within the last 5 years52mg LNG IUS in situ but been present for >5 yearsd41d0ab9-5bd3-43e2-b7c3-01ddca3fd38dfalsefalse{\rtf1\ansi\ansicpg1252\deff0\nouicompat\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
{\colortbl ;\red12\green12\blue12;}
{\*\generator Riched20 10.0.18362}\viewkind4\uc1
\pard\f0\fs20 Please note that the licence for use of \cf1 the levonorgestrel-releasing IUS for the progestogen part of HRT is now 5 years (had previously only been 4)\par
}
falsefalseHRT supply issuesfalse4b20ce9b-f6b2-4628-8a34-b3818dcff275falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18 If there are supply issues, please see the following links for alternatives/get up to date stock information:\par
}
2df5756c-09fe-4077-9b03-097ecc34a9abfalsefalseBMS HRT alternativeshttps://ardens.live/BMS-HRT-alternatives96828a22-8658-4220-8999-d1e6c80438edfalsefalseMIMS drug shortageshttps://ardens.live/MIMs-drug-shortagesb329e555-2d3d-47eb-a512-39888bb800bffalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18\par
\par
}
falsefalseExaminationfalseae61c5b7-6105-445c-adc8-75e1bc7b216ffalsefalsefalsefalse8de0f59d-ee98-4a78-9e8f-ddf356fbf767falsefalseO/E - blood pressure readingfalseSNOMED_CONCEPTfalse1a22eabc-fc0e-431b-b86f-442899a2fe75falsefalseSNOMED_CONCEPTfalsefalse23261f4a-9b17-4d55-8f3e-4614942be346falsefalseSNOMED_CONCEPTfalsefalse94c573c1-c33d-49ee-a699-f38001fcb430falsefalseBody Mass IndexfalseSNOMED_CONCEPTfalsefalsefalsePlanfalsea0286547-e21e-4119-b23b-6495b4076b6afalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\b\f0\fs18 Please use the following code to record completion of an HRT review:\b0\par
}
35134f0d-8877-41e5-b808-fafdfa742e7efalsefalseSNOMED_CONCEPTfalsetrue295b4fd7-0683-477d-a42d-e346f9791901falsefalsefalsetrueHappy to continue HRTWould like to stop HRTWould like to try alternative formulation of HRT516daaea-7631-43dd-a17e-d8f9295f74cdfalsefalsefalsetrue356942b1-c1f0-4777-a248-8b547c687584falsefalsefalsetruefalsefalseFollow upfalsed4eb431f-c26e-4dcc-9c4e-5535a8665530falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18 Advise patient when HRT review is due:\par
}
ef64f4fa-02d1-476b-a00a-1999b1589ca7truefalseSNOMED_CONCEPTfalsefalsePCGS Meno/HRT Fracture Risk Ass.0145f533-7ff9-4c97-b5d8-9cea48a2334f1Meno/HRT Fracture risk ass.falsefalseHRT and bone healthfalse2653352e-fd85-4775-a77f-398c9284157dfalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fswiss\fprq2\fcharset0 Tahoma;}{\f1\fnil\fcharset0 Tahoma;}{\f2\froman\fprq2\fcharset2 Symbol;}}
\viewkind4\uc1\pard\f0\fs18 One of the benefits of HRT is to \b\f1 reduce the risk of fragility fracture\b0\f0 . This benefit:\par
\pard\fi-360\li720\f2\'b7\tab\f0 is maintained during treatment but decreases once treatment stops \par
\f2\'b7\tab\f0 may continue for longer in women who take HRT for longer\par
\pard\par
Please see the following link for a table of absolute rates of fragility fracture for menopausal women taking HRT compared with no HRT (or placebo\f1 ) - please scroll down to osteoporosis section:\par
}
53025cdc-ccf5-438d-87d7-4701770e26cbfalsefalseNICE - Long term risks and benefits of HRThttps://ardens.live/HRT-long-term-risks-and-benefits6c7cf507-5d7f-4c20-9ed2-20ce827df14cfalsefalse{\rtf1\fbidis\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}{\f1\fswiss\fprq2\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\ltrpar\f0\fs18\par
\f1 NICE recommend discussing bone health and reviewing fracture risk at menopause and HRT review appointments.\f0\par
}
23d4b2a4-3ec7-470b-9354-b5d4281ef339falsefalsefalsetrue7cd2d70c-f527-4d50-8379-1bdf7d05a924falsefalseSNOMED_CONCEPTfalsetruefalsefalseWho to assessfalse8aa1b98d-90a2-41cd-9c92-0baa7006f6b3falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fswiss\fprq2\fcharset0 Tahoma;}{\f1\froman\fprq2\fcharset2 Symbol;}{\f2\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18 NICE advise considering assessment of fracture risk in all women aged 65 years and older, and in women aged under 65 years in the presence of risk factors:\par
\pard\fi-360\li720\f1\'b7\tab\f0 previous fragility fracture\par
\f1\'b7\tab\f0 current use or frequent recent use of oral or systemic glucocorticoids\par
\f1\'b7\tab\f0 history of falls\par
\f1\'b7\tab\f0 family history of hip fracture\par
\f1\'b7\tab\f0 other causes of secondary osteoporosis\par
\f1\'b7\tab\f0 low body mass index (BMI) (less than 18.5 kg/m2)\par
\f1\'b7\tab\f0 smoking \par
\f1\'b7\tab\f0 alcohol intake of more than 14 units per week for men and women.\par
\pard\par
NICE advise to not routinely assess fracture risk in people aged under 50 years unless they have major risk factors.\par
\par
\i NICE, 2017\i0\f2\par
}
dc85bb87-90ba-4143-84dd-576269b27222falsefalsefalsefalseMeets criteria for fracture risk assessmentDoes not meet criteria for fracture risk assessmentfalsefalseRisk Assessment Toolsfalsea7664d8d-e99a-4c43-89ce-57f5d090c4cafalsefalse{\rtf1\fbidis\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fswiss\fprq2\fcharset0 Tahoma;}{\f1\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\ltrpar\f0\fs18 There are 2 commonly used risk assessment tools which will produce a risk estimate for overall risk, and risk of hip fracture:\par
\par
\b\i QFracture or FRAX.\b0\i0\par
\par
To calculate the risk score, click on the hyperlink to launch the chosen calculator. Enter the final values into the relevant boxes below to record in the notes. \b Please be aware of the recommended age ranges for use as specified on the website.\par
\par
\b0\i Please be aware we have no control over, and accept no responsibility for, links to external websites. Please check your results carefully before using them to form a clinical opinion.\i0\f1\par
}
f15ecc0f-f33e-45c5-b3fe-17c8f63c68a7falsefalseQFracture (ClinRisk) https://qmasters.info/qfracture4a87aaa6-5018-46c6-941d-cfb546af3c7ffalsefalseSNOMED_CONCEPTfalsefalse509e6a14-6969-4d72-99cb-468adf8ab547falsefalseSNOMED_CONCEPTfalsefalse59d0fc78-c622-49a6-867f-2d1bddc1b5cafalsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\f0\fs18\par
\par
}
6bb5ae20-26a9-42d2-bf1b-b2a8999238dcfalsefalseFRAX Tool (University of Sheffield) https://qmasters.info/FRAX-tool25647dcf-8b76-4def-a3f7-191ab4d19ee2falsefalse{\rtf1\fbidis\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}{\f1\fswiss\fprq2\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\ltrpar\f0\fs18\par
\b\f1 Please ensure you use the correct code to record your score as results will change depending upon whether or not you include bone mineral density in the calculation:\b0\f0\par
}
8439958a-c8ba-4022-9e9d-9127045e6312falsefalseSNOMED_CONCEPTfalsefalsea7a1fea3-2f0b-4402-a723-38a91970c995falsefalseSNOMED_CONCEPTfalsefalse5ec3060a-c802-4303-b73e-5300769cdbe1falsefalseSNOMED_CONCEPTfalsefalsef3569406-fd9c-4a83-846c-4296f85b24abfalsefalseSNOMED_CONCEPTfalsefalsefalsefalseBone densometryfalsec43c1c0a-1275-46a5-b074-6602a2d2c84ffalsefalseSNOMED_CONCEPTfalsetruefalsefalseBlood testsfalse4b83c017-aba0-4d74-a265-5a3cba950462falsefalse{\rtf1\fbidis\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fswiss\fprq2\fcharset0 Tahoma;}{\f1\fnil\fcharset0 Tahoma;}}
\viewkind4\uc1\pard\ltrpar\f0\fs18 Consider assessing for vitamin D deficiency and poor calcium intake.\f1\par
}
83de13d2-656f-4255-8151-eca9cc99ce0efalsefalseSNOMED_CONCEPTfalsetruePCGS Meno/HRT Referrals2a2f9a82-47c6-47b5-8371-5e0a41ed22271Meno/HRT ReferralsfalsefalseReferral informationReferral informationtruedfa157a9-3f3b-4084-b2fe-ba978304f6b1falsefalse{\rtf1\ansi\ansicpg1252\deff0\deflang2057{\fonttbl{\f0\fnil\fcharset0 Tahoma;}{\f1\fnil\fcharset2 Symbol;}}
\viewkind4\uc1\pard\f0\fs18 Consider referring to a healthcare professional with expertise in menopause if:\par
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{\pntext\f1\'B7\tab}Ongoing troublesome adverse effects\par
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\viewkind4\uc1\pard\f0\fs18\par
If there are red flag symptoms such as unexplained bleeding please consider arranging an urgent 2 week referral to gynaecology:\par
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\viewkind4\uc1\pard\cf1\f0\fs18\par
For psychological symptoms, such as mood disturbance, anxiety, and depression, consider referral to self-help groups or CMHT for cognitive behavioural therapy (CBT):\cf0\par
}
7717b996-065a-4e75-8d4c-98a7c8b29be2falsefalseSCT_READV2falsetrue0a77355e-0eb5-473b-861e-501a11828b19falsefalsePCGS Meno/HRT Resources22d186e0-9b51-470f-8593-8263e9b967f91Meno/HRT ResourcesfalsefalsePatient Resourcesfalsea4eb635f-4c49-49f4-905a-034da3d10244falsefalsePCWHF Menopausehttps://ardens.live/Menopause-remote-consultationd7b23ad0-913a-450a-880f-dbcb961b71fefalsefalseMenopause leaflet - Royal College of Obstetricians and Gynaecologistshttps://qmasters.info/menopause-patient-rcog0441fe82-e3cd-4d8c-bf42-f4b9c198fe46falsefalseMenopause - patient.infohttps://qmasters.info/menopause-patient-info14fc539a-b808-4456-bd37-1951f66a02adfalsefalseFactsheets - Women's Health Concern (British Menopause Society)https://qmasters.info/factsheets-womens-health-concern0b363369-5fda-4af8-9264-518faf990c67falsefalseMenopause mattershttps://www.menopausematters.co.uk/81a466de-480f-493c-a729-0a9f511d6bedfalsefalseThe Daisy Network - Support group for premature menopausehttps://ardens.live/The-Daisy-NetworkPCGS Testosterone - Androgen Def709bd9fa-d9ea-4622-a12b-fe169edfc8571Testosterone Androgen def84dc1f13-dd4d-4439-a556-99eff5448827New Section 1aac0f590-1593-4b04-88f4-fd558db92ad0falsefalseSNOMED_CONCEPTfalsefalseAMa8edd15c-c0f8-4fa6-b98d-4e07093386fcfalsefalsefalsetrue0f00c23c-ca8c-420b-afc9-e8fbbab30fa0falsefalsetruefalsePatient lacking motivation/energyPatient complaining of myalgiaPatient complaining of mood change or anxietyPatient concerned about lack of libidoPatient does not have symptoms of androgen deficiencyad1cb051-876c-4a71-bcae-e4c4fa80e9bafalsefalsefalsetrueede0167c-b6e3-49ce-b864-763d0c7395eafalsefalsefalsetrue179f23a7-174a-451c-9203-c296bd90c01dfalsefalseSNOMED_CONCEPTfalsefalse1cf55b9d-ed22-441d-89e2-3eb032f227d4falsefalseSNOMED_CONCEPTfalsetruea3e837d0-ba65-48f7-80a4-82d3c99c943cfalsefalseSNOMED_CONCEPTfalsetruecca073b9-79e6-4b5e-bc3b-83870b9ba25cfalsefalseSNOMED_CONCEPTfalsetrueb3553e41-ff3e-43e0-9004-548819e976fefalsefalsefalsefalsePCGS Testosterone - Formulations2a3b49a4-c475-4b24-bcc0-1110e78d7bfe1Testosterone formulations1f8ce001-d704-4c55-b76b-a696be63994eNew Section 18db4c148-30f5-48c7-80eb-49c97d668beefalsefalsefalsetrueTestim 50mg/5g tube - 1/10 of tube per day (make tube last 10 days) ALERT: 30 boxes = 300 daysTestogel 40.5/2.5ml sachets - 1/8 sachet daily ALERT: box of 30 = 240 daysTostran 2% gel 10mcg/0.5mls - one measure on alternate daysTestogel 50mg/5ml sachets - 1/10 sachet daily23a2975e-5da8-439c-b3a0-1caca4b2da0bfalsefalsefalsetruefc154a0e-0690-46a4-99a1-6957310b4b33falsefalsefalsefalse21abbd44-3066-4edc-8bce-af5a92e13fccfalsefalsefalsefalsePCGS Testosterone - Monitoring093d82f4-c6c7-4ef5-95f1-8b62fea21b5b1Testosterone Monitoringa089d678-5a82-4cf5-bd6a-1404e1bbe9d4New Section 171d35252-4c85-4a75-922c-656186b23156truefalseSNOMED_CONCEPTfalsefalsec350eb18-6c84-4c45-857f-e394896a4e79falsefalsefalsefalse1b926aa4-04d4-4ebc-ad16-dc8c0cbe489bfalsefalsefalsefalse