'People may think it’s just hot flushes but actually it’s fascinating'

Amanda Hillard’s move into the field of menopause was a bit of an accident, but a lucky one as she recalls. “I decided to work in menopause when a clinic sister left at King’s College Hospital. I thought I’d do it for six months, then move on. But 17 years later, I’m still working in it. And I love it,” she says.

For Mrs Hillard, it’s the variety that appeals. “People may think it’s just hot flushes but actually it’s fascinating. You treat the woman holistically so you look at bone density, cardiovascular disease, and diet and exercise as well as menopausal symptoms. There is always something new happening.”

She sees many patients who are well versed on all aspects of the menopause so keeping on top of current thinking is vital. “I try to listen to programmes such as Women’s Hour, read women’s magazines or watch programmes on BBC iPlayer if I know these are relevant. I need to know what they say so I can tell my patients if I agree or not, and why I feel that way.” Paying attention to the media, being an active member of professional societies and reading journals is how she maintains her knowledge - but the fast pace can be tough.

Mrs Hillard fits it in around running the once-weekly afternoon clinic where she sees 4-6 patients, usually referred by their GPs. More complex patients - perhaps with breast cancer or other medical problems - are seen in the mornings by her, a consultant and specialist registrar. The rest of her week is taken up with other specialist gynaecological clinics, such as a post-menopausal bleeding clinic and a vulval clinic.

“I have great relationships with my patients,” she says. “Sometimes it is hard to discharge them; they enjoy coming and talking about their symptoms and treatments.” Treating those symptoms has radically changed in the past 10 years. Mrs Hillard says women started using HRT less after concerns about the associated risks. “When the scare regarding the risk of breast cancer and HRT came out in 2002, there were doctors ringing women at home telling them not to take it, really terrifying people. Perhaps some shouldn’t have been taking it while others really should, but hopefully now we are seeing more rational prescribing.”

She says while sales of HRT dropped, sales of alternative therapies and services - acupuncture, aromatherapy and more holistic approaches - increased. “You have to bear in mind people may not have the money to try all these things so you have to introduce and approach them carefully,” she says. “Some women try one thing and it works straight away, others have to try a few. I am all for trying things that don’t cause any harm but I have to make women aware there is little evidence base for some of these therapies, unlike with HRT.”

One thing she has suggested to women is LadyCare, which some people believe to work by boosting levels of oestrogen and progesterone. Falling levels of these hormones are responsible for many menopausal symptoms. The same technology can ease or eliminate menstrual cramping, but it was originally designed to help the body cope with menopausal symptoms such as hot flushes and insomnia caused by night sweats.

Retailing at about £20 and lasting forever, the technology is quite popular. “This is a good solution that has worked for some women because of its low cost. I understand it’s been used by policewomen and by some of the nurses here in the hospital, with good results,” says Mrs Hillard. “As I say, I am all for women trying anything that helps as long as they are aware of the limitations and the lack of clinical evidence, as long as it doesn’t cause any harm to them.”

She says having the flexibility to try new things is vital because her patients are of all ages - specialising in early menopause, she may see women as young as 16. “It’s great to see these young menopausal girls go on to lead full active lives, sometimes achieving pregnancy and know that I’ve been able to make a difference and help.”

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