Janice Turner on the Menopause Industry

I'm dipping into the chapter on bone density in oestrogen matters.

Bone density can be increased pre menopause through exercise and diet. It can't post menopause unless on oestrogen.

It goes on to explore the huge industry around osteopenia which is where bone density tests show slightly reduced. Osteopenia is a "debated disease", as it's felt the levels are normal. However it seems it's not bone density but "flexibility." And it seems many osteoporosis drugs eventually lead to greater risk of fractures. It doesn't seem to reverse the condition.

The chapter is complex exploring the different drugs but the take home is summarised here:

[merail] I'm about to have an OT grumble about the quality of the advice that has been available for osteoporosis.

A lot of the advice has been daily walking etc. being sufficient. Long story short, a comparatively short time ago, it became apparent that slight women are literally too light to generate the force impact that is necessary to lay down bone in the way that had been assumed.

So, some of the public health advice had not taken physics + the diversity of the adult human female force into sufficient account.

Now, for quite some time, public health has advised strength training as well. However, there is still a mass of misunderstanding around this and it hasn't been taken up on a sufficient scale.

[/merail]

I am aware of treatment for osteoporosis as family member has it. I am hoping to slow down the decline. And I do take Vit D and calcium

The alternative marketing is bigger than lifestyle changes. It's special menopause vitamins, soya isoflavones, black cohosh, ginseng and various essential oils. Other stuff too I can't quite remember. So, it's very real.

The first time I heard about HRT was from a couple of women I knew who used it. The Davina doc for sure and one other doc I can't quite remember who did it.

As I have said I hate the faff and would rather not take it but am in a high risk group for osteoporosis. Some people are evangelical about HRT and I guess if it helped them as much as they say then I can understand it. Of the 4 (only) 4 women I know who use it 2 were evangelical and 2 were meh.

Form my point of view it's hard to have a consensus as everyone's biological make up and life experiences (nutrition, exercise, weight, hormones, stress, sun exposure for vit d, pregnancies etc) are very different. Anorexia in teen years predisposes you to greater risk of osteoporosis for example.

Not the best analogy but with hypothyroidism, Some people need to have very suppressed tsh to feel well, others feel awful and need it to be less.

If in peri and meno you're not experiencing symptoms perhaps you don't need it. Clearly there's a lot more research needed which will take time.

Women on hrt also can also get osteoporosis

as I understand it, all women are at risk of osteopenia/osteoporosis in later life if they do not go on HRT.

it’s the all women part that sounds like we should all be using it regardless of symptoms

This is where I’d like more discussion

With osteoporosis HRT can help
Afaik all the data compares women on hrt for menopause - likely with symptoms- with those not on hrt

To my way of thinking this could confound factors relating to diet and exercise - you are more likely to need hrt with poor diet and exercise and more likely to get osteoporosis- untangling the different effects has not been attempted

And I would like research not sponsored by hrt selling companies

Alternatives to HRT - usually means dietary changes, supplements that you can buy OTC, either starting, changing or increasing amount/type of exercise, things to aid sleep like wool duvets, cool pads, etc.

Argument that all women need HRT - as I understand it, all women are at risk of osteopenia/osteoporosis in later life if they do not go on HRT. It may be that some women are at more risk than others for hereditary, personal health or dietary reasons - I'm not sure about this - but it was one reason why I wanted to go on HRT as I have osteoporosis in my family. I remember Dr Newsom also talking about heart disease and dementia risk, but again I'm not sure what the science says about this.

The menopause board is a bit of a mess. I’m not sure if there are posters pushing messaging or not - given the high £ market rate and the audience here it could be happening, whichever way questions are often aggressively shut down and misinformation isn’t countered.

A thread on feminist board where it’s women-centric not marketing led seems better.

There seems strong consensus that it’s main use is for symptoms and should be accessible, I don’t think many would disagree

The phrases I see and question is the idea that it is vital - vital for all women?

Also re dementia - this has grown legs and is repeated but evidence is lacking and in some cases carries small increase in risk

re osteoporosis - again who just those at risk? Or all

The thing is there are alternatives for women who wish to balance their hormones without medication. I've balanced mine naturally. I was really suffering in December - but back to normal now after taking a whole body approach which has set my body up to age healthily as well. I've used specific nutrition to impact and support my hormones favourably and allow them to function as they should. I've also taken charge of stress which underlies so many of our menopause symptoms (this is not spoken about sadly) and changed parts of my life and put myself first and I have to say I'm on fire & not afraid of menopause at all now. I can really say, I'm thriving!

@DivorcedAndDelighted I think what you say is true... HRT is not marketed nearly as much as alternative stuff.

@JoodyBlue I have not found irritability has improved and in fact am more irritable. But it's early days so might settle.

@JoodyBlue I agree and so did my DM (who loves horses), and that's why she wouldn't take it.

I disagree about 'appeasing others' though. My DM's menopause symptoms made her awful to live with. I know it must've been hard for her too, so when I felt those 'red mist' type symptoms myself and realised that I was entering that phase I knew I wanted to do something about it.

Menopause affects us all differently and clearly many women welcome the changes that come with it, but for me that feeling of my emotions being out of control and serious anger constantly bubbling below the surface was unacceptable (among other things too, which are all well-known symptoms). We should all be able to make an informed choice about how we want to manage our own menopause. I'd welcome a leaflet being sent to every woman on her 40th or 45th birthday by the NHS explaining the symptoms of menopause and what the treatment options are for women who wish to treat it.

HRT doses transdemally are far lower than the oral medication of the contraceptive pill.
Also, you are only replacing that which was lost, not giving a dose of something already there to try and alter a cycle.

This book goes into all the studies and benefits to date. I found it fascinating.

(Also mentions impact of pb on womens brains too)

https://www.amazon.co.uk/Oestrogen-Matters-Hormones-Menopause-Well-Being/dp/0349421773/ref=mpssa111?adgrpid=69648715196&gclid=Cj0KCQjwkruVBhCHARIsACVIiOwQtShhpcRQ-hpha2BiN4-PaZcIkLOyB13HyTsCu6rX32XtMn9lJysaAkR7EALwwcB&hvadid=345406846953&hvdev=m&hvlocphy=1006948&hvnetw=g&hvqmt=e&hvrand=4986736387922403927&hvtargid=kwd-507278138596&hydadcr=168800_1798495&keywords=oestrogen+matters+book&qid=1655706147&sr=8-1

I found hrt to have an antidepressant effect.

No. Body identical, that being transdermal oestrogen and micronised progesterone (utrogestan which can be taken orally or vaginally) is safer.

I have the rage at the moment, and I can assure you I’m not enjoying being ‘not nice’. It isn’t just shit for the people around me, it’s absolutely awful for me too. I got furious with a make up pencil lid the other day FGS!

It isn’t just a matter of being a bit grumpy and being outspoken. It’s not refreshing to speak my mind. It is completely irrational fury which makes me feel like a monster. I have had to stop reading the news as everything makes me angry, I’ve turned into Victor Meldrew!

This anger is what has made me go to the doctor and request HRT. I have had awful joint pain and foggy head for about 18 months, but the anger is the thing that has made me pull my finger out and do something.

DivorcedAndDelighted I was reflecting on just that when I first saw the article.

The real "menopause industry" that may be exploiting women is the alternative medicine/ supplement / coaching one.

There's as many people and companies making a huge amount of money out of it without using hrt.

A friend was seeing a menopause coach who was basically giving life tips, and some supplements, thinking hrt was "problematic medicine." It was only after both I and another friend pointed out transdermal body identical hrt is "natural" that she ditched all that and the huge bills.

I was rattling with supplements; Dh commented that it was the most expensive "illness" he knew of.

come along now, I'm trying to have a considered discussion about medication for the menopause and obviously not talking about medication for conditions like epilepsy

<sigh>

I find the marketisation of menopause very interesting, but from a different angle. A year or so ago I started looking into my options. Boots had a leaflet about menopause. It was full of suggestions of supplements and skincare products I could buy. Didn't mention HRT. Holland & Barrett have plenty of things to sell for menopause, from supplements & skincare to foods. My Facebook feed has plenty of adverts for mindfulness for menopause, natural menopause, workshops, supplements, cooling clothing, special bedclothes, etc.. I've been given books about natural menopause full of ideas for things you can buy which might ease some symptoms. Many of these "natural menopause" sources disparage "big pharma", which wants to, shockingly, sell me drugs.

I had a consultation with a private menopause specialist at Newson Health, while waiting for my NHS menopause clinic appointment. They both recommended the exact same thing, which was estrogen gel plus Mirena IUD. The estrogen gel cost about the same on private prescription or NHS prescription charge, about £10 a month - a fraction of what I could easily spend on "natural menopause" products. I think I read that most commonly used HRT products make very little money for the manufacturers.
So yes, menopause is being marketised, but the demand for HRT seems to be mostly led by women asking for it. In contrast, what is marketed to us via advertising are alternatives to HRT.