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

It is still given orally, though, AFAIK, without the involvement of quadrupeds these days.

OTOH, HRT does have some potentially life-threatening risks, which is not generally true of SSRIs (some exceptions but they are very rare). HRT definitely increases the risk of breast cancer and, for oral HRT, blood clots

I am not sure oral HRT is still given? It was made of horses' urine in the 1980s! We've come a long way since that!

Yes I agree. GPs need to be properly informed (I think I understand more about the menopause than some of them appear to, just from reading the newspapers and MN!) and they need to stop saying HRT causes breast cancer. Modern bio-identical HRT is very unlikely to. If someone wants it they should be able to have it.

Equally GPs should be properly informed about the alternatives, and how to help women who can't or don't want to take HRT.

And all the nonsense like menopause moisturisers needs to stop.

But employers do need to make allowances for women who need those allowances and we need to stop the narrative that they will use it as an excuse not to employ women over 50 because they don't want to employ women of any age and policies systematically affect women badly such as forcing people back to the office when they could easily work from home.

As for erectile dysfunction, it doesn't affect a man's ability to work, doesn't give him brain fog and doesn't make him bleed heavily. Completely different issue. Also doesn't affect all men.

It's a fair point about the need to discuss the risks of all options, and I agree that the risks of antidepressants - especially loss of libido - are often played down.

OTOH, HRT does have some potentially life-threatening risks, which is not generally true of SSRIs (some exceptions but they are very rare). HRT definitely increases the risk of breast cancer and, for oral HRT, blood clots.

This is another of the reasons why many doctors find it hard to advise women: you are balancing a risk of horrible symptoms now - and I agree completely that the menopause can wreck quality of life - with an increased risk of a potentially fatal disease in the future. That is a hard decision to advise on for any medical treatment, but it is much harder when we have so many uncertainties about the scale of the risk.

We urgently need research, particularly on whether the current practice of giving everyone with a womb (not gender bollocks - I mean women who have not had a hysterectomy) both oestrogen and progesterone as HRT. We know that giving oestrogen only increases the risk of endometrial cancer, but I have a suspicion that, over all, this risk may be lower than the increased risk of breast cancer with combined oestrogen and progesterone (NB this is only a suspicion at this stage - no one should stop taking progesterone, and I take it myself). We also don't know whether the risks of combined oestrogen and progesterone HRT are the same if you have the progesterone through a Mirena coil as if you take it by mouth.

It does annoy me that the discussion around HRT focusses on its risks and not on the risks of antidepressants or indeed of not taking it at all - it's not a panacea but it can be life-changing.

It's also frustrating that, like so many conditions predominantly affecting women it receives less funding.

But it also annoys me when I see people claiming HRT fixes everything when there are risks and benefits to be weighed up.

And I am increasingly enraged by the proliferation of menopause branded haircare, skincare and supplements galore sold in a huge wave of meno-washing when the evidence for the benefits of these is dubious at best.

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.

In sum, yet another example where women deserve better.

As the saying goes, absence of evidence is not evidence of absence. I agree with you that many patients find that HRT relieves lots of menopause symptoms beyond just sweats.

As several PPs have said, the menopause (like many aspects of women's health) is very under-researched, and what research does exist is by Pharma, so focuses on selling women stuff (HRT), not on alternatives. We can't expect Pharma companies altruistically to research alternatives to their products; we need independently funded research through universities and other research bodies.

The paucity of research is one reason why patients get such different views from different doctors. There are a huge number of uncertainties about HRT, with the research having totally contradictory findings in some cases, especially its effect on cardiovascular risk and dementia risk. I genuinely do not know, when prescribing HRT, how likely it is to harm the patient. That is a very uncomfortable situation for a prescriber - and for the patient.

I often offer HRT, only to have a woman decline it when we have a discussion about the possible risks. And I'm not trying to put anyone off - I use HRT myself, despite some family risk factors. and I have prescribed it for women who are high-risk, as long as I am satisfied that they understand those risks. But the situation is a lot more nuanced that the Davina take that "All woman should be on HRT and it's only evil GPs who are standing in their way". All of us: doctors and patients are currently in the dark about many important issues on the safety of HRT and effective alternatives.

Two wrongs don't make a right

Women should be able to access HRT pretty much on request

But we shouldn't be giving the impression that menopause is automatically a disaster for women because it's untrue, and unhelpful

And we shouldn't wholeheartedly support an industry whose priority isn't helping women but is helping their bottom line because the two goals may ( often do ) conflict

That's appalling. I'm so sorry.

It took me 7 years, a year's worth of proof using my fitbit that I wasn't just doing fuck all all day and I had osteoporosis by the time I finally got it.

Of course it depends on your GP. Lucky you that you have one that doesn't want women to crumble before her eyes.

I think that depends on your GP. Mine has virtually been pushing it at me - she asked how things were going when i was there about something else.. My only symptoms so far have been irregular periods, so I don't see the point (though i doknow thr argumentabout preventing osteoporosis etc,) but it's clear it wouldn't be a problem for me to get a prescription if I felt I needed it.

Women do not take HRT for shits and giggles.

We are usually on our knees before we are deemed worthy of it.

No, Alison, you're misreading and putting words in people's mouths.

The worry is that by failing to distinguish clearly between menopause itself on the one hand and the ways in which it can go wrong for some women on the other, we are reverting to a narrative in which older women are boxed in by perceptions of them that define them in terms of some flawed reproductive essence.

We've had people on this thread tell us it is all simple, just lift weight, just bathe in magnesium, just do some CBT or visualisation or it is all in our heads.

You started a thread demonising women for whingeing about a natural phenomenon and for taking HRT. You reverted to this narrative, not me.

I'm absolutely fucking elated that there is an industry making HRT for women. It means I can walk.

So if you have never experienced the horrors then great.

But of course women who actually know what a difference it has made are going to be angry at the suggestion that they fell for a marketing scam:

Now we are being sold a false narrative that seems to regard pathologising the menopause as a form of empowerment.

Women wanting to walk/use their limbs/remember words for simple items after the age of 50 is not empowerment, it is completely normal.

Yeap and I bet there has been more money poured into supporting men with erectile disfunction than menopause

I am well aware that all women experience the menopause. I am well aware that some don't seem to experience the debilitating symptoms and want the women that do to stop being all mental about it and to shut up talking about it lest it drive forward a desire to treat the symptoms which are all in their heads as they just need some CBT and visualisations.

It's no wonder we fucking crack with this level of patronising bullshit that is endlessly thrown at us.

Periods are also a natural part of women's lives. But many women have extremely painful periods with no clinical diagnosis of endo or anything. So they need medication in order to function.

Some women (me) have horrendous pms. etc etc.

Some women have signifucant cognitive and physical impacts of menopause beyond a "transition in life, have some cbt" experience. So HRT can be very helpful. Not to mention its protective against various health issues and oestrogen supplement help pelvic floor function too...

Here's a wee rage-indusing paragraph in the report:

'Menopause happens to all people with typically functioning ovaries who reach the relevant age. We recognise that this population includes some transgender men and other gender-diverse people; therefore, in some instances, we have referred to “people” rather than “women” to be as accurate and inclusive as possible. However, since much published work refers to people experiencing menopause collectively as women and does not clarify how findings might apply to the specific needs of gender-diverse people, we have also used “women” in some instances, to avoid inappropriate generalisation. Evidence on menopause in gender-diverse individuals is scarce and needs more attention'

Obviously not. Not all women experience those symptoms, although all women of that age group will experience menopause.

"The body is more than equipped to deal with it, but mentally can be a different problem due to the severity of the symptoms."

Mentally I am a-okay, I even sleep well, but for the last three months I have been suffering muscle pains in all large muscles plus the neck. The first four years of peri Menopause werent a problem. I am mid 50s but now am hobbling around like a 90 year old. Neither exercise nor massages or warm baths helped beyond short term relief. Getting out of bed in the morning HURTS!
If I don't do anything, this will affect my ability to move and walk in the future, because I feel massively tired now and try to move so that it doesn't hurt.
I am going to see my Ob-Gyn about HRT. No need to let something like this run its course and lose my health.

The process and changes that stop a fit and healthy 49 year old woman who worked in physical jobs her whole career unable to climb the stairs is normal?

Crikey.

Full disclosure - I'm on HRT

I am actually thinking of coming off it as I've recently upped my dose but it's not really doing anything anymore so not sure it's worth it.

I'm lucky in the sense that all my symptoms have been physical and I haven't been plagued by the anxiety or low mood that so many of my friends/colleagues have experienced. The reason I went on HRT was because I basically stopped sleeping. I was also permanently boiling and wearing a T-shirt to walk the dog in the snow, but while annoying I could cope with that. The lack of sleep was really starting to get me down though. After trying various approaches for a few months and also realising that my periods had become increasingly rare I went to the Dr who put me on HRT.

I found my sleep improved, the hot flushes improved, the constantly itchy skin I had (which I hadn't thought of as menopause related) also disappeared. My nails broke less and all sorts. However, a year later the old symptoms are creeping back and despite increasing my dose of HRT aren't going away. So I may stop. I don't worry about osteoporosis etc because I am very fit and active. I run, lift weights etc.

I'm really on the fence with this one. Yes we don't want to medicalise a perfectly natural process but at the same time why should women suffer if they don't need to. After all child birth is a natural process too but it hurts like hell and most people think it's a good idea to provide pain relief...

But thats the point the paper makes - menopause itself isn't a dysfunction. Symptoms may well be, but the process and changes are a normal part of women's lives.

If you substitute menopause for erectile disfunction

"The paper argues that menopausal hormone therapy (MHT) should be available for those who need it, but the evidence showed it was only effective for hot flashes and night sweats, not other symptoms."

I had neither of those symptoms - what I had was debilitating fatigue and joint pain that left me feeling like I'd been hit by a bus when I woke up every morning. It came on over the course of about 3 months. Within another 3 months I was on HRT and my symptoms entirely gone.

I'm sure it is not for everyone, but I've heard only positive experiences from my peers (women in our 40s) who are just starting to go on HRT.