{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T23:18:17Z","timestamp":1794007097078,"version":"4.8.0"},"reference-count":47,"publisher":"Informa UK Limited","issue":"2","license":[{"start":{"date-parts":[[2018,3,22]],"date-time":"2018-03-22T00:00:00Z","timestamp":1521676800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Post Reprod Health"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Referral audit \u2013 are local recommendations required to translate guideline to practice?<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>In total, 50 consecutive, anonymised referral letters reviewed during the initial consultation in a specialist menopause clinic; the reasons for referral along with the patient\u2019s age and the source of referral were analysed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Several common reasons for referral were identified. Sexual dysfunction, including loss of libido and dyspareunia, resulted in 11 (22%) referrals. Ten (20%) women were troubled by persistent symptoms or side effects from HRT; 9 (18%) women were referred before hormone replacement therapy was discussed or commenced; 7 (14%) women seeking advice for their menopausal symptoms had a family or personal history of cancer; 5(10%) were migraineurs; 2(4%) women had premature ovarian insufficiency; 2(4%) were denied hormone replacement therapy because of concern about venous thromboembolism risk; and 4 (8%) had miscellaneous medical disorders. Over 25% of referrals were older than 60.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Menopausal symptoms are predominately dealt with in primary care where advice and support is needed. National Institute for Health Care and Excellence published guidance regarding onward referral to a specialist menopause clinic, which is vague and referral patterns are haphazard. Our audit highlighted areas of clinical uncertainty and formed the basis for providing local pre-referral information and advice. Some of the information provided is quite detailed and aimed at healthcare professionals with a special interest in menopause. Further training is now required to improve the quality of referrals. The diversity and complexity of some referrals illustrates the need both for a menopause specialist and clear pathways for further advice or referral within each region.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/2053369118762241","type":"journal-article","created":{"date-parts":[[2018,3,22]],"date-time":"2018-03-22T03:35:29Z","timestamp":1521689729000},"page":"83-96","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Service evaluation project \u2013 Are local recommendations for onward referral to a specialist menopause clinic required to translate guidelines into practice?"],"prefix":"10.1080","volume":"24","author":[{"given":"Anne Marie C","family":"Neill","sequence":"first","affiliation":[{"name":"iCASH Clinic, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"301","published-online":{"date-parts":[[2018,3,22]]},"reference":[{"key":"bibr1-2053369118762241","unstructured":"National Institute for Health and Care Excellence. Menopause: Clinical Guideline \u2013 methods, evidence and recommendations (NG23), Version 1.5, www.nice.org.uk\/guidance\/ng23evidence\/full-guideline-559549261 (2015, accessed 19 May 2017)."},{"key":"bibr2-2053369118762241","unstructured":"Sexual Health Fundamentals.\n                      Talking with patients about sexuality and sexual health\n                      . 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