Talk up menopause in discussion groups

Women who are moving into the transition years have many valid concerns and questions that often cannot be answered in a single office visit. Providers pressed for time in the stepped-up pace of today’s medical scene are torn between stacked patient visits and the desire to help patients fully understand the dynamics of menopause.

How can you solve this problem? Supplement the information provided in your office with menopause discussion groups. Not only do such groups serve as an effective vehicle for disseminating information, they also allow women to help themselves by sharing their personal experiences.

The Cleveland-based North American Meno pause Society (NAMS) has developed a booklet to aid providers in forming such small groups within their communities.

Women strongly desire those types of groups, says Nancy Siskowic, MSN, NP, CNS, a Torrance, CA, women’s health nurse practitioner with a specialty in midlife and menopause. "Women respond immediately because they all have similar concerns" she says. "They don’t realize that many of the symptoms they are having are part of menopause, and they feel so validated when they realize that."

Menopause is not a disease, and discussion groups are not support groups in which participants need mental health support. Rather, they are forums in which women to do most of the talking, says Miriam Rosenthal, MD, who aided in development of the NAMS booklet. She is chief of the division of psychological and behavioral medicine at University Hospitals of Cleveland and associate professor of psychiatry and reproductive biology at Cleveland’s Case Western Reserve University.

Bigger is not better when it comes to discussion groups. Groups should have enough participants to keep the discussion going, but they should allow each woman to have a turn at expressing her concerns, says Rosenthal. Groups can range in size from about five to 15 women, with eight seen as an optimum number.

Whether it’s a clinician, a health educator, or a counselor, make sure the person heading the group is a facilitator who can help the group achieve its desired goals. While the facilitator allows each participant to talk, he or she must be strong enough to intervene if the discussion is monopolized, stresses Siskowic.

Keep "hidden agendas" out of the way when serving as a facilitator, says Rosenthal. Those who are of a singular mindset, such as pro-hormone replacement therapy or herbal therapies only, should put ideologies aside when working with discussion groups.

An informal needs assessment can help determine whether a menopause discussion group would be beneficial for your patients. If there isn’t a group in your community, the opportunity is open. If such a group does exist, with the number of women now entering the menopause transition, there is room for growth. Also determine the target audience for your group. Will it be women of all ages, or just peri- or postmenopausal women? Keep your group unique for the greatest success.

How will costs be covered? One approach is to solicit funding from various sources, such as pharmaceutical sales representatives, a managed care group, or a local pharmacy or fitness center.1 Those who contributed to the NAMS guide said the groups that charged participants a fee were the most successful overall. Charging a fee can aid in covering costs, as well as solidify commitment among group members. However, be sure to offer a sliding-scale fee or perhaps a scholarship underwritten with outside funding to help those women who may not be able to afford the fees.

Once you have determined the need for a menopause discussion group, advertise it through such avenues as in-house posters, mailers to other clinics or providers, and community fliers. Then prepare for the first meeting. Start it on time and focus on two key tasks: determining how the group will reach its goals and attending to social relationships within the group.1

"I always ask, Why are you here? What brings you here? What are your burning questions or concerns?’" says Siskowic.

Groups generally meet for six to eight sessions, says Rosenthal. They can cover varying topics, such as exercise, diet, emotional aspects, and other lifestyle issues for midlife women.

"We talk a lot about the hormonal and herbal [approaches]," notes Siskowic. "I want to get them listening to their bodies, because their body has all the answers."

From the onset, group members need to know what to expect and what is expected of them. By signing and keeping a copy of a "ground rules" sheet, everyone has a firm understanding of the purpose of the group.

While menopause discussion groups provide women with accurate and up-to-date information, they also facilitate sharing experiences. By helping one another understand their choices and empowering themselves to be informed and take of themselves, women in discussion groups gain both individual and group benefits, she says.

Reference

1. Boggs PP, Rosenthal MB. Helping women help themselves: Developing a menopause discussion group. Menopause Management 1999; May/June:12-16.

The North American Menopause Society has organized a "How to Develop a Menopause Discussion Group" kit. It contains a 48-page discussion group booklet, a copy of the Meno pause Guidebook, a current suggested reading list, and an order form for additional copies. The kit costs $15 for members and $21 for nonmembers, with an $8 shipping charge for orders up to $25 and a 7% sales tax for Ohio residents. To order, contact the society at P.O. Box 94527, Cleveland, OH 44101. Telephone: (440) 442-7550. Fax: (440) 442-2660. Phone orders are not taken. NAMS suggests use of the on-line order form at its Web site: www.menopause.org, or a photocopy of the on-line order form.