"Doctors warn against over-medicalising menopause"

[flashbac]

"Writing in the British Medical Journal they said there was an urgent need for a more realistic and balanced narrative which actively challenges the idea that menopause is synonymous with an inevitable decline in women’s health and wellbeing..."

www.theguardian.com/society/2022/jun/15/doctors-warn-against-over-medicalising-menopause-after-uk-criticism

I must admit, the raising awareness of how shit the menopause can be has created some worry about my impending menopause, so much so that I've decided against a career change in my 40s.

Are we making too much of a big deal and being overly negative? Or are these doctors just being patronising? Anyone had an easy menopause?

If public healthcare took women's health needs seriously the Stratford's market would be those who elect to go private rather than those who are just desperately trying to be taken seriously.

But so many women (who have had awful, awful symptoms) have had to fight (and not always succeeded) to get HRT. Which works.

There have been huge, huge strides made thanks to Newson and Davina. People are talking about it. Pennies are dropping "What you mean I do not have to feel this fucking awful?" "Shit, so this is menopause - I thought I had demensia." "I have been spending £45 a month on supplements which are not working I still feel like shite but HRT is worth trying as I tick all the boxes".

Women who have been suffering no longer are.

This article could really, really, really undermine it. Put menopause back in the "It is your age, just put up with it" box.

NO!

No, you shouldn't medicalise it if people are not having symptoms. But please let's not put us back in our boxes. Please.

MarshaBradyo -- different outcomes, Alzheimers vs. all-cause mortality.

I am a research scientist, and I find HRT a complex subject.
I'm all for taking it if you know it makes your life hugely nicer. I don't believe in perfect decisions, anyway, and if you're alive now with a problem that needs solving now and you have a solution now that can't be more than a tiny bit risky (we can be fairly sure about saying that with HRT).

There must be people who are blinkered against it... but I only hear voices online of those who treat HRT like a cult.

That's where the "medicalising" comes in : I see a lot the view on MN that (peri)menopause is an-always-health problem and hugely risky: this is very blinkered. it's not helpful.

Using DXA scans to diagnose osteoporosis is problematic, btw, I don't find that metric useful at all. So all this scare stuff about future osteoporosis: argh.

I think you will be more likely to find consipracies about how frequently women with menopausal symptoms have been prescibed anti-depressants in the past......

Some are definitely cult like about HRT- You will see it on the MN menopause board - you get made to feel that you are stupid if you want to consider not taking HRT, and as if you will get dementia/heart attack/ osteoporosis (and it's implied that this would be your own fault ) as if the evidence was that clear.

No, you shouldn't medicalise it if people are not having symptoms

There's a question over just mild symptoms though surely. Everyone's different in terms of what they are prepared to put up with/ how willing they are to take medication.

Any excuse to defund female healthcare.

Although perhaps now transwomen "experience menopause" too, there might be more done about it.

The studies were of women who already were taking hrt ...

It's an incredibly poorly researched area

This article could really, really, really undermine it. Put menopause back in the "It is your age, just put up with it" box.
NO!
No, you shouldn't medicalise it if people are not having symptoms. But please let's not put us back in our boxes. Please.

Jeez, did you read it? Or did you read the article in the BMJ the Guardian piece was talking about?

www.bmj.com/content/377/bmj-2021-069369

It seems, the answer is NO!

Because the authors of the BMJ paper and you agree on this main point:

No, you shouldn't medicalise it if people are not having symptoms.

Yeah, I was getting most of that mid 40s on a progesterone only contraceptive pill. I've recently switched back to one with oestrogen as well and all these symptoms improved within a few days.

@EggRollsForever

Not disagreeing that HRT can help all of those symptoms at all but I don't link those with ageing as such - ageing to mr means getting older. Which we all are & can't stop.

Symptoms described that are alleviated by HT are to me physical issues that need to be addressed but aren't what I'd regard as ageing.

Jeez, did you read it? Or did you read the article in the BMJ the Guardian piece was talking about?
Yes I did actually. Both the guardian piece and the BMJ article. And the fact that 2 of the BMJ authors are involved in alternatives to HRT (CBT books and a pharma alternative to HRT). Interesting huh?

Yes, I agree with them, you don't need HRT if you don't have symptoms (unless future research shows otherwise). But both pieces said more than that - and to me, they were not very pro-women. To me, the jist of the first half of the BMJ piece seems to say if you don't have severe symptoms you can cope. And that if you expect it will be bad, then that will mean you are likely to feel your symptoms are bad. So buck up and smile through it. Back in the 80s women coped with it. Why do women need to know about the medication available - if it wasn't marketed at them they would just get on with it. So, yes, it feels like a "get back in your box, stop making a fuss" tone. With a "let's stop talking about this so much as people think they need HRT because they have seen Davina". Really?

Do we need to stop having childbirth classes as (as PP have said) "birth is natural, why do you need pain relief". If we tell women about epidurals and pethidine they will all take it - it medicalises birth. Has that happened? Or are there just better outcomes for women and babies?

Menopause wise - women are unlikely to visit/econsult a doctor if they do not have symptoms. People are less like to visit/consult a doctor if they do not know that their symptoms can be dealt with. Menopause is not being over-medicalised. It is being discussed and women are becoming informed.
Surely informing women about HRT is important? It is informing. Not over-medicalising. Informing them about choices, about what symptoms can be eased, and what cannot, about the fact their symptoms are not just "old age" but lack of oestrogen - which can be fixed. Informing them that their aches and pains are not age-related/bone degeneration/arthritis - but fixed with oestrogen. Informing them that yes, they can actually sleep a full night through again. Why is knowing this a bad thing? That actually, they have symptoms - which are affecting their quality of life - but they don't have to suffer from them. Why is it a bad thing to know that many GPs are untrained and uninformed about menopause and HRT - that you may have to advocate for yourself.

Both the guardian and BMJ treat women as fucking idiots. "Medicalisation of menopause as a disease requiring treatment prepares women to expect the worst."Fuck me. Really? Are women that fucking stupid that we cannot assess whether our symptoms are negatively impacting on us? We only feel shit because we expected to feel shit. And we should do CBT or alternatives rather than HRT. Which works?

Absolutely.

We are only just starting to understand menopause and people are trying to shut down discussion - madness. We want more research. More conversation. More tv shows. Yes some will be clumsy - do we need workplace awareness? Who knows. But it’s a start. For too long women have thought they had depression/dementia and were getijng the WRONG meds.

Thanks for the link to the article that has the dementia research. That's quite worrying, as I thought I had read elsewhere that there was more positive evidence than that, although some mixed/negative as well.

but as it's specifically Alzheimers I'm concerned about, that tells me I should probably try to deal with any symptoms in another way. So far I'm in the very earliest stages, so mostly just hot flushes, but I am waiting for results of a Dexa scan at the moment and I hope that they don't recommend it for bone density issues as then I'd have some hard choices. I know the article said there didn't seem to be an increased risk for oestrogen only, for longer times (at least I think that's what it meant), so maybe that would be enough to help with bone density should that be the issue. I drink plenty of milk, so calcium not likely to be an issue. Weight bearing exercise not so much, though I do try to walk. I'd like to jog but end up with constant injuries no matter what I try. Even walking can be an issue and causes falls or pain in itself.

I am sure there must be research going on still into the dementia risks, given what a big issue it is in society, but it's hard when you have to make choices now.

Using words like ‘cult like’ is shutting women down even if you don’t mean to. Globally womens healthcare is worse than mens. If women are now having lightbulb moments about an area of health that has been hushed up/silence/shamed for so long, why not embrace it and help? If dexa scans aren’t great, what’s the best thing to do? Where is the preventative advice?

Yes it’s complex and individual according to age, health, family history, genes etc. But also the stats around breast cancer don’t mirror the level of fear. It’s like worrying about flying compared to driving a car. Of course we all want ZERO risk which means we need more research and fast.

Great post @JimmyMcNultyIsMine I agree with everything you’ve said.

'Any excuse to defund female healthcare.'

That doesn't make sense though. Hospital care for treatment following osteoporosis related fractures plus care home/ social care of those with dementia will be millions if not more. To save this massive drain on nhs resources it would of course be in the Government's interest to reduce the burden, if this could be achieved through encouraging HRT why isn't there a big public health drive rather than just Davina rolling out clinicians generally with private practices?

It seems to be because the evidence isn't clear, there aren't further large scale studies underway (why??) so no-one really knows. It's a case of take the risk and hope for the best with HRT.

I know - it’s a shocker. Add in smoking and obesity and the risk is stacked against someone.

GPs do try to tell us this! We don’t like giving up the fun stuff.

I am enormously glad about the increased social and medical awareness of menopause and hrt.

It meant that, as I sank deeper into crippling anxiety, I became aware of the possibility that it was menopause related. Despite coming from a family culture of ‘only bother the doctor if a limb is hanging off’, I did consult a doctor and my life is much better as a result.

The long term ‘physical’ health benefits are of less concern to me. The dramatic mental health benefits, which cbt had barely touched, are life changing for me.

Agree. There should be far more research on preventative medicine. It’s a massive topic.

MNers are very enthusiastic about proactive medical interventions, the BMJ is very worried about over-treatment.

DEXA scans are diagnosis tools. They don't prevent anything.
Osteoporosis matters because it results in broken bones : wrist is main one, also hip & neck. Certain numbers on DEXA correlate with chances of getting those broken bones. Reveal thresholds that would help you get somewhat useful medications or equipment. But the correlation isn't perfect.

Being obese also correlates with breaking bones. Even though obesity is protective for maintaining higher bone density (on a DEXA scan). Men age ~80+ start having a higher risk of broken bones than women even though they have higher bone density (on DEXA) at this age... why? There's a lot about bone-breaking risk that the DEXA scan can't tell us.

How to reduce chances of getting osteoP.

I was pleased to see this article. Menopause has become totally polarised. If you have symptoms of course you should have treatment, but there are women who are unaffected by the menopause. It is surprising that Newson's recent survey says that more women than ever are struggling with menopause (with the broadest collection of symptoms now attributed to it) when life generally is shitter than ever? And of course won't everyone have perimenopause when its a condition without a clear definition? Someone is selling the idea for women that any aches, mood disturbance etc is fixed by HRT.

I think Newson will face a lawsuit in her time, she doesn't offer tailored menopause advice. She tells everyone they should have HRT and there's hardly any risks. She is advocating treatment on a huge scale for which there has never been a trial on; start HRT in midlife and stay on forever.

Yes I agree re small risk and using it if needed, I would without hesitation if necessary for me.

I think this thread shows reactions can be unduly defensive which is a shame, there’s no threat from people asking questions re long term health outside immediate symptoms

I appreciate your posts btw with the info

As you say in your post you don't keep up with all the HRT reproach because you don't care. You hardly make a case for listening what you say then.

Research not reproach.