"What we’re seeing is an incredible emergence of a for-profit industry associated with menopause"

Menopause is the beginning of proper sickness and death for women. Ofc we should medicate the arse out of it.

you can, but you still have to talk to the pharmacist (quite rightly)
Just woman up and go and speak to the doctor, then you will get it free

You can buy oestradiol cream or pessaries over the counter from a pharmacy (Vagifem).

@RedToothBrush

"It leaves women in this void between the two, unsure who to trust and who really has their best interests at heart."

This link from The Lancet (March issue) has 4 free articles (+ editorial) on menopause and some other interesting ones including Richard Horton's comment "Offline - Towards Shangri-La" on trust.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00462-8/fulltext

Dr Margaret McCartney who I hugely admire, wrote the Patient Paradox in which she describe the phenomenon of the 'Worried Well' in which she describes how huge portions of society are now conditioned to be worried about their health so they are vulnerable to health marketing that plays on their insecurities.

The flip side to this is just how HCP don't listen to patients and dismiss their symptoms as being nothing.

It leaves women in this void between the two, unsure who to trust and who really has their best interests at heart.

I do believe that for some women, HRT is quite honestly life changing and does make all the difference both in the short term for their mental health and in the long term for their physical health.

But for others its not the solution and I actually have deep concerns about them. I have at least three friends for whom HRT just isn't an option. What happens to them? They won't be prescribed by an NHS doctor for those reasons. But still could potential buy the drugs on line elsewhere quite legitmately.

The hype surrounding HRT means there is this risk. There isn't a a discussion about how you support women for whom its NOT suitable. Its one of those magic bullet theories.

It results in either women being deprieved of a drug thats pretty much going to ensure their well being or at the other end of the extreme, being exploited for something which is whole unsuited for their needs. And fuck all understnading or options in between.

In every situation women are screwed over.

With bells on.

This has been my point for some time. Menopause has been medicalised in a way that makes it look like an illness all women have. It's a massive pile-on to make profit out of women, who are 51% of the market. None of the stuff being pedaled has any use for most women - most of the stuff are placebos which 'might' make you feel better because you think it will! The real problems women have with menopause require visits to GPs not off-the-shelf remedies.

Maybe media attempts at discussing menopause or advertising/advising on menopause should start with a disclaimer regarding conficts of interest and non-medical/medical background of the author(s), just like any author of a published scientific article.

Celebrities playing doctor and celebrity-status doctors, often advertising their own brand of products, or being sponsored by pharmaceutical/supplement companies, dominate the debate, and many seem to find pleasure in discrediting scientific data (and lack thereof), as if the lack of scientific data or a couple of flawed HRT studies justify potentially dangerous treatments.

This would definitely help women seeking unbiased evidence-based information.

I do get that. And theres no way I could have done that when I first was given hrt. It's not easy. Women also it seems need entirely different exercise approaches.

Re thyroid; levels were affected by coming of hrt (testosterone) and then the operation and then starting tamoxifen which is something that directly interferes with it like oral oestrogen does. They (rightly) wouldn't test till things had stabilised which took a few months.

I think that's extremely well balanced now after this last raise, better than in years - but there again I've always known that's better when I'm doing certain types of exercise, which I wasn't doing a couple of years ago. But that is me and I know every one is different, especially with thyroid things .

@Ikeameatballlunch

I agree with all of that. The problem is with saying diet and exercise to someone who is already doing that and still suffering.

Re thyroid issues - have you tried liothyronine or one of the NDTs? Mine never really stabilised until I added active T3.

Thanks @ArabellaScott

Mostly - hot sweats back this week and social anxiety is a bit high; but I went out partying and drank a few Proseccos at the weekend. And had very little sleep due to that and a child with nightmares. Things like that do seem to make things worse. But the exercise definitely makes it all more manageable.

It's the thinking skills I'm most delighted with. The brain fog before was crippling. (And it's been awful recently with low thyroid levels) I was absolutely terrified of not being on hrt and starting tamoxifen. Hrt had helped a bit. But it's so much better now even with tamoxifen, which does cause brain fog. I forget names of things and do have the odd day where I'm wiped, (which is as likely to be thyroid related) but can handle concepts and concentration so much better. My joints are better too.

When you start listening to the 'cancer and menopause influencers' (dr Liz o riordan, Dr Annice Muckerjee who is an endocrinologist who also had cancer) you start to see a bigger picture which takes in a wider range of things. Even Davina admitted in an instagram live with Danni Brinnington who runs Menopause and Cancer podcast and group that she doesn't drink alcohol, exercises loads, especially resistance training, and clearly has done Zoe according to the ads for that.

Re things like dementia and cognition, certain types of exercise have more evidence than hrt. Liz is especially keen to point this out and I think Newson blocked her on Twitter.

I also don't understand how dementia / Alzheimer's risks are actually lower for women who've had AIs and tamoxifen. As they block oestrogen.

Hrt does have its place, definitely. I don't want to say it doesn't. And we actually don't know the risks with hrt after breast cancer as they've only researched synthetic progesterone, (which is a risk, they think oestrogen on its own isn't) not utrogetstan. But actually, for those who can't, there is a huge amount out there too.

Vaginal oestrogen is very welcome though and I can take that!

I didn't say women should not have help for e.g. menstrual cramps. I said I was worried about the commodification of health care and the use of gimmicky gadgets to control medical problems that have actual medical solutions.

I'm glad you're feeling better, ikea. Sounds like you've done amazingly well.

I was on hrt after increasing issues with perimenopause symptoms though I'm also hypothyroid and I think they affected each other. It helped with some things but bleeding was worse and that was half the issue. Testosterone was great but was only on for a couple of months.

Was diagnosed with breast cancer a year ago (it had probably been growing for 10 years) so had to come off it and on to tamoxifen (just lumpectomy and radio needed)

Have to say I really do see the aggressive marketing of menopausal products and supplements. It's exploded in the last 2 years. Facebook bombards me with stuff I can't take and I know won't help.

And what's never mentioned is boring old diet and exercise. Because it's almost free. It's taken a year and I did take 6 months off to deal with coming off hrt, side effects of tamoxifen, op recovery, radiotherapy and fluctuating thyroid levels (which I've only recently got on top of) but i genuinely feel better than when on hrt.

I feel lucky that I was diagnosed with the cancer (not least as it was dealt with asap) because I could take the time to really work on my lifestyle. Some nights I didn't sleep at all thanks to half hourly sweats when starting the tamoxifen and I could t have worked. I have primary aged children and they needed me.

It's been specifically resistance training that I feel has helped the most, and eating for building strength. More recently SIT training, via 'next level roar' by Stacy sims. More protein, but mostly plant based. I'd already read the xx brain by Lisa mosconi and I do think that's really helpful if on or not on hrt. (She seems to be getting on the hrt bandwagon though.)

The whole gut biome thing has helped hugely. I had terrible gut issues. Hrt helped a lot. (Maybe tamoxifen is helpful, I don't know.)

Stacy sims worked on the women's health initiative as a research scientist.

I went to gp with sudden crashing headaches that had me lying in a darkened room for 4 hours. Rarely had headaches previously.
Expecting a brain scan, got HRT. Headaches gone, but now I've got heavy bleeding and fibroids. Tough choice really.

Evening primrose oil is recommended for menopausal symptoms. Not tried it so not quite sure what it does. But worth a try?

Motherwort or Ashwaganda, just bear in mind that herbs are powerful and some have contra indications, best to consult a qualified herbalist but they can really help. Ground linseeds in smoothies, porage etc, can help with hot flushes.

I probably expressed myself badly. I meant medication that is not needed and does not help with either symptoms or outcomes but can be passed-off as a remedy. HRT etc and herbal remedies are fine, either prescribed (HRT) or researched and found in a health food shop.

My issue with prescribing menopausal women ADs when HRT is likely to help, is that the fact you've had them is on your records. From that time on, every time you have something (physically) wrong, a GP (assuming you can see one) will say you're anxious or depressed and fob you off with more medication for those, even though you know it has a physical cause.

We know women get fobbed off already, and you don't want GPs to have any more ammunition. People of both sexes get fobbed off when they and consultants can't find a cause for things and say it must all be in the mind because they can't be bothered to look harder.

Also if you are feeling rubbish during menopause, you are likely to feel low. That doesn't mean you need ADs, it means you need the physical symptoms sorting out.

The most annoying part about the whole issue is that I have found that I've not been listened to, or when I have (swollen achy joints, hands and feet) not my GP nor the expensive (to the NHS) consultant rhuematologist that I was referred to, had any idea that this was a menopause sympton, which could have saved a battery of expensive tests and time for patients who were in need of rheumatology input.

I started a private HRT prescription halfway through the referral process, and mentioned that my symptoms had improved considerably as told it couldn't possibly be because of the HRT and that I just had minor osteroarthritus due to wear and tear, normal for someone of my age.

What I find really insulting is that women's experience of their own bodies and health is routinely downplayed, minimised and discounted. This is male medical bias, it's normal and it needs to be called out. We're not hysterical - we know our own bodies.

@EmmaEmerald I originally found that comment on Jen Gunter's paid for site Vagenda (worth the small cost in my view). This summary is in the public domain https://www.health.harvard.edu/blog/menopause-and-memory-know-the-facts-202111032630. I do like the way they frame it - this language should be more common in workplace guidance - "On average, women perform better than men on measures of verbal memory, beginning as early as post-puberty. However, women's advantage for verbal memory performance is reduced with menopause."

@MissLucyEyelesbarrow It's the downplaying of the risks of osteoporosis that particularly bothers me - hip fracture is sadly common (I've seen stats suggesting more common than breast, endometrial and ovarian cancer put together) and has a lower survival rate, and HRT is shown to reduce the risk of fractures.

I think that is all fair, and illustrates a lot of themes on this thread. We should avoid dismissing the mood/emotional aspects of the menopause, but also avoid attributing everything that women experience to low mood. It's really hard to get right, even when you are trying really hard to do so!

The honest answer is that you cannot always tell at the outset what the best treatment for an individual is, and you need to be honest with the patient about that, pay attention to her preferences, and be open to changing treatments, if they aren't helping.

What worries me about the current push to promote HRT and criticise GPs who offer anti-depressants, is that HRT is not what all women want, or what suits all women best. I agree with your mother that, in general, antidepressants are over- prescribed. However, one group of patients who often do really well on them, even if prescribed for quite a short period, are menopausal women. We don't want to push women who could really benefit from ADs towards HRT, if that may not suit them as well.

@UnaOfStormhold “And I would like workplace discussions around menopause to reflect that while women's performance on memory tasks undoubtedly declines in menopause, it declines to the level typically seen in men.”

this needs to be all over the information at work! Do you have a link to any research please? Thank you.

As I said before, my mother is a doctor (US) and she feels that GPs (herself included) really don't understand anti-depressants well enough to be prescribing them and feels strongly that only psychiatrists should prescribe them.

Ha, good luck with that. The US has 11 psychiatrists per 100,000 population. The UK has 2.

Interesting language about women being 'fobbed off' with antidepressants too. Are we saying that only physical ailments are real, and that treating the mood disorders of menopause is somehow less valid?

Antidepressants are not the right treatment for all women with menopause mood disorders, but the choice is by no means clear-cut, because of the complex inter-relationship between physical and mood symptoms. Some women find their lives transformed by HRT. Some women find their lives transformed by anti-depressants. Some women should not be on either. It is really unhelpful, and contrary to the interests of women, to characterise one treatment as being superior to the other, when the evidence does not support this.