An interview with Angela Wright, GP, Menopause Specialist and Clinical Sexologist
Can you introduce yourself?
I’m Angela Wright , I am a GP, Menopause Specialist and Clinical Sexologist. I work in Masham, North Yorkshire. It’s a practice with just under 6,000 patients, with five GP partners. I have a background in Hospice medicine bizarrely.
I did a palliative care diploma after qualifying as a GP. And I worked in a hospice for a decade; I think that it was this that sparked my interest in a holistic approach to medicine.
How did you get interested in women’s health and sexology specifically?
When the youngest of my three children started school, I was working part time and was ready to build up my sessions. I had just left hospice as the night shifts were exhausting me, and I was trying to figure out what I wanted to do with my career.
As a female GP I fit coils and implants and see women at all stages of their reproductive life. I kept being asked questions that I didn’t know the answers to about sex and pain. I saw a Diploma in Clinical Sexology advertised online which sparked my interest.
“Once you get that lens to talk to people about their sexuality, you start to understand what worries people are walking around holding and not having anywhere to take them”
Then whilst studying for this, I wanted to learn more about the underlying biology and physiology from a medical perspective. I applied to attend the Advanced School in Sexual Medicine, run by the European Society of sexual medicine, which is a ten day intensive course in Budapest for Doctors working in Sexology. From that I went on to sit and pass the fellowship exam, so now I’m a fellow of the European Committee of Sexual Medicine.
It became really evident that I was using my skills the most with women around menopause, so I thought it made a lot of sense to do training in menopause, so I did the FSRH/BMS Advanced Menopause training.
I don’t think that when I started all the training I would end up using it so much – it was really based on my interests – but once you get that lens to talk to people about their sexuality, you start to understand what worries people are walking around holding and not having anywhere to take them.
You have recently piloted a webinar series and support group proactively informing your patients around HRT, menopause, and sexual dysfunction, can you explain how and why this started?
I started to get quite a lot of women coming in to see me, saying “I hear you’re the person to speak to about menopause”, and I started thinking that maybe I should have a session where I could try and reach a lot of women all in one go.
Access to information about women’s health is often dreadful, I see women struggling all the time because they haven’t been made aware what’s happening to them, or what options they may have.
“I didn’t want our patients struggling with their menopause when I have this information”
Who do you want your patient to learn menopause from? Someone who is knowledgeable and who can explain it as they need to hear it? Or the alternative can be that they come into surgery clutching an article from the Daily Mail, which may be sensationalist or misleading. I think if we fill in some of the information gap ourselves, it actually helps us in the end. That was why I was doing it. I didn’t want our patients struggling with their menopause when I have this information.
The Town Hall is where we have previously held meetings for our patient group, but it wasn’t an option due to covid. I used the practice Facebook site to float the idea of an online webinar: in the end there were about 100 attendees, which, for our practice is a lot!
Our next webinar is PMT/PMDD, progestogen sensitivity and contraception. I did one on Female Sexual Dysfunction. It’s all been Women’s Health issues at the moment but there’s definitely scope to do it for all sorts of things.
In the end what we’d hope is that we have a library of recordings. I have saved the ones we have done and use the links to direct women to have a look and then they can come back to discuss what they want me to do to help them.
What does a typical webinar format look like and what resources are needed?
I think a lot of us have resources already we could use: if you’re already teaching GP registrars for example. The menopause session I did first was based on something like that: so it’s not as much work as you might think to take those slides and make them accessible to patients, then to tack on half an hour of Q&A for patients at the end.
A webinar is 1 -1½ hours so even if you just did one four times a year, once you’ve recorded it you’ve done the hard work.
Claire, our practice manager, has been great in helping me: she collates the questions from the chat board or that have been sent directly to us ahead of the night. That means that the names are kept hidden, it’s that facility that gives it good scope, to allow questions to be asked anonymously.
The support group we are running in ten days or so will be different, people can talk to one another and have their cameras on. It will be a safe space. The idea is that we will meet on Zoom every couple of months and I’ll just choose of a section of CBT for menopause to talk about, and then do a Q&A session at the end.
How do you use these resources after the live event?
I have put links to the recordings on the practice Facebook page. And also saved them in vimeo. I direct patients there when I think the information will be helpful.
Of the women who attend the webinars, I ask them, rather than overwhelming us with demand at the moment when we’re so busy with appointments, to register that they would like to discuss further with me using eConsult. I can then work out what to do. Whether I need to see them or whether I can organise a prescription or a phone call.
You said that it has saved you time in your practice, how has it done that?
It addresses a lot the questions that I used to get coming back two or three weeks later. Somebody would phone in and say they want another appointment because they needed to ask me more questions. Or they hadn’t started their HRT because they had second thoughts. Or asking me what was it I said about how to put the gel on, or I’ve just remembered my aunt had breast cancer and what does that mean etc.
I think people often struggle to absorb and retain all the information regarding something as complex as this. The videos help as a resource to avoid these sorts of extra queries. They can also see its their own doctor giving the advice. So, they know its info I think is relevant to them.
You could have three or four appointments just to get to someone to the point of starting HRT. People are often still nervous of it or not sure how it sits with the other options. Having the webinars works to answer all those questions. They’ve got a resource to refer to in their own time. And it’s somebody they trust telling them.
What was the response to these additional resources from both colleagues and patients?
The feedback was good from patients. There is lot of appetite for doing more of them. I have proposed to do a series in Women’s Health first; but I can do it on male sexual health as well.
What advice would you give others who might like to set up something similar?
I think for those of us with a speciality, I think it’s possible to enjoy sharing your subject. It doesn’t feel like such hard work because you are already passionate about it. You often have resources already that can be quickly adapted for use with patients. Zoom has really opened up how easily you can reach large numbers of patients for minimal time invested.
It is an hour or so out of an evening a few times a year and it can really help in the quality of care you provide. If we are able to improve health at these key stages in patients’ lives, I am sure it will save money and time further down the line.
With women given proactive care at menopause, you should be reducing fractures, cardiac issues, diabetes prevalence, dementia, prolapse, vaginal dryness, urinary issues. It’s well worth informing women in how to look after their health as they get older.
What benefits have you seen since setting this up?
I haven’t officially monitored this yet so I can’t quote how much time it is saving. I have definitely seen a lot fewer people than I would have done for those 20-minute consultations; that often even overrun that because of all the questions! They get the information beforehand, everything gets made more efficient.
Initially of course I am creating work in getting these women adequately informed and better looked after. Hopefully that time investment will mean that in 10- 20 years they’ll be in a far better health than they would have been if we hadn’t tackled it at that stage.
Proving the benefit of an intervention like this would need to be done with quite a long-term study. Just drawing attention to the things we can do to improve our health from menopause onwards would have huge impact.
For me, it’s about wanting to raise the bar of what we see as “normal” for women as they age. When we are proactive, we can feel confident that women will do much better in their 60s,70s and beyond.
Have you other plans for the next year?
My friend and colleague Dr Angela Sharma and I are planning on launching an online clinic. Called Spiced Pear Health, in July or August.
We both have a similar skill set and believe in this proactive approach. She has created a menopause clinic in her practice in Notting Hill. This has a similar aim of raising the bar for these women; being more proactive in improving chronic disease as we age.
We want the clinic to focus on giving a bit of a health pitstop at menopause. So, doing bespoke menopause care; but also being proactive. Using our clinical sexology skills to help with women’s sexuality as they go through this transition.
We are both very passionate about the impact of hormonal issues on women’s health. As well as the need to better inform and support women with their sexuality and general health as they age. We are applying for benefit corporation status. We are making educating and reaching in underserved populations a big focus in what we do; alongside the private clinic side. For example, we are already working with Maggie’s to offer our skills to their users. We have been involved in other pro-bono work. Work where we feel we can improve access to knowledge and skills in that area.
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We built our own bespoke consulting software to allow us to build our consultation around the persons aims. This captures your issues before the appointment in your own words and build the conversation and the options around that. We want to give a wide ranging, bespoke plan going forward. So women have a clear idea of what they can do to take charge of their health and sexuality in the future. We are really busy still honing it and trying to get things ready for launch, but it’s really exciting.
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