"Doctors warn against over-medicalising menopause"

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"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?

Yes
I agree 100%.

Sounds like prevention is key with osteo. More women need to know this.

I really don't understand what you mean! These are not symptoms of ageing? You have a menopause and your vagina starts to atrophy and the support to the rest of the genito-urinary area is lost causing this? This isn't ageing of your body? What is it then? I genuinely don't understand you. What are you saying causes these symptoms?

*What is vaginal atrophy?

Vaginal atrophy (also called atrophic vaginitis) is a condition where the lining of the vagina gets drier and thinner. This results in itching, burning and pain during sex, among other symptoms. The condition also includes urinary tract problems such as urinary tract infections (UTIs) and frequent urination. Vaginal refers to the vagina while atrophy means “a wasting away or diminution.” Recently, the term vaginal atrophy has been replaced with the newer term, genitourinary syndrome of menopause (GSM). This new term helps describe not just the vaginal, but also the urinary symptoms that can be accompanied by the effects of low estrogen.

Vaginal atrophy most often occurs during menopause, the “change of life.” This happens because of a decrease in the hormone estrogen. It can occur in younger women, as well, when their estrogen levels are affected.

Hormones are produced, stored and secreted by the endocrine system, a network of glands and organs. Women need the hormone estrogen for good health, especially during the child-bearing years. When menopause happens around age 50, the ovaries produce fewer hormones and the woman stops having a monthly period. There are many uncomfortable symptoms for women during that time, and that includes vaginal dryness and other symptoms that might indicate vaginal atrophy*

So much of whether you are high risk for osteo happens in childhood or is due to genetics though:

• childhood malnutrition/neglect


• long term cortico steroid use (e.g. severe asthmatics)


• petite, thin body type


• Auto-immune conditions


• ethnicity- white or asian


• family history

The issue is thinking meno is a year or two of symptoms or ‘sailing through’.

Menopause is a man made term and a bit misleading. Hormone changes happen throughout life. Women might benefit from hrt products to help prevent serious illness but there is a woeful lack of research around this. Hence all this debate

So the thought women are ‘not affected by menopause’ - you can’t really know that til end of life because it’s a nonsense term in many ways. It is just a term used to define women who are no longer fertile (thanks medical world)

The reality about breast cancer risk is that you can be T total, have an ultra healthy diet, non- smoker and no family history and you still have a 1 in 7 chance of breast cancer.
HRT is a problem if you have a hormone sensitive tumour. Most tumour will have been present for between 2 and 9 years before they are palpable, many are only found on routine scans. She me are not found until they have reached the stage where they can only be treated palliatively. Although HRT only causes a small increased risk surely if HRT is not essential ( ie mild symptoms ) we should not be encouraging women to take it because it’s the latest trend.
Menopause for many women is short lived, it occurs at a time in life when so many other pressures are arising such as aging parents and teenage children are testing you.
I would love to say that stopping HRT was the worse thing that has happened to me but in actual fact I feel great. I have coped with some pretty heavy duty stress over the last 10 mnths and pretty much sailed through it. I will admit that 5 yrs ago I was a fire breathing dragon before starting HRT but now I totally rock at being cool , calm and collected.

I am not on HRT (yet) but my mum is 83 and has been on it ever since her mid/late 40s. She would never give it up.

I recently attended a webinar where the doctor said that HRT is merely replacing hormones. It also has major benefits for reducing risk of osteoporosis, heart disease, strokes and dementia.

Whether medicalising or not, if something has a major impact in reducing the risk of dementia, never mind the other benefits, it is worth it. Think about how that will reduce care bills in the future, if 80% of women no longer have dementia.

Also, people only ever talk about "medicalising" when it comes to women. I wonder why doesn't have to wonder very hard

Yep. So why isn’t the nhs telling women this? Those at high risk given practical advice around load bearing exercise, nutrition, not smoking etc. hrt possibly but clearly nhs won’t commit to that one. Private doctors do though… go figure.

Although HRT only causes a small increased risk surely if HRT is not essential ( ie mild symptoms ) we should not be encouraging women to take it because it’s the latest trend

For most women it actually reduces the risk of breast cancer.

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

I am also worried about overtreatment, such as making everyone with slightly but not significantly raised blood pressure take medication for the rest of their lives. But HRT is not one of those concerns for me. Anyway, if you don't want to take it, you don't. But don't tell other people what they can and cannot have, it doesn't affect you. At the moment I am not taking it but I would like to think it would be there for me if I needed or wanted it, without nosy do-gooders preventing it.

Menopause isn’t short lived - see my other post about lifelong hormone fluctuation. More research is needed on its preventative benefits (which Includes some cancers)

Yes I agree the issue with breast cancer risk and prediction. GPs will ask if you have family history and offer scans to women over 50. Other than that who knows who will get it. So women are having to guess whether hrt is right for them. But also - if you are worried about cancer the best thing to do is not drink alcohol or smoke.

Is it any surprise that menopause has become a major topic over the last couple of years when like every other age group we have been forced to spend large amounts of time unable to go further than the four walls of our own homes. Like teenagers there has been zero escape from our everyday lives.
Menopause has just compounded this just as it has in hormonally labile teenagers.

I think pioneering women in senior medical and research roles has prob done this! Funnily enough men haven’t been so motivated.

I agree it is over medicalised. It is not a given that you will need HRT to get through it, but it's there if you need it.

I am someone who 'sailed though', I know I'm lucky. Why should I take HRT? I get free prescriptions so the taxpayer would be footing the bill for me to take medication I don't need.

There is a definite strong message that you should start taking it at the first symptom, and not stop until you die otherwise you will look like a story book witch, and be hobbling around in a daze by the time you are 70. I believe there are very few women who really need to do this, but I would in no way want those women who do need it to go without.

I don't usually swear much, but fuck them.

I went straight into menopause in my very early 40s. I can't bear to think how miserable life would have been without HRT. Who wants to lose their sex life because of a shrivelling, dry vagina, as well as the other usual symptoms?!

Smoking and alcohol are no longer closely associated with breast cancer. The biggest risk factor is being a woman with breast tissue. You can give up anything you want but it doesn’t necessarily make you breast cancer proof.
The most commonly asked question in the breast cancer support group I am in is “why me, I don’t drink, I don’t smoke , I have a healthy diet, I exercise and I breast fed all my children. I did everything recommended so why me”
I think women can be very smug about how good their health is, believe me it comes as a shock to every single one of us.

I was told this by the NHS actually. In my 30s as I am high risk for osteo and already had signs of it when a knee injury was being treated.

Because that’s the message they want you to hear. Plenty of post menopausal women enjoy full happy sex lives. Why do you think they invented viagra? It was so the husbands didn’t get dumped.

So they presumably didn't get HRT so don't believe other women need it

But they do believe that some women will need HRT. They’ve not said otherwise in their article. And as for whether they have had HRT, no idea and I don’t think we can make such an assumption.

'For most women it actually reduces the risk of breast cancer.'

Where have you read this?

Here, from the key messages box in the article, they wrote:
Although some women with troublesome menopausal symptoms benefit from menopausal hormone therapy, other effective treatments are available and a narrow focus on symptoms fuels negative expectations

If women feel they need medical help to go through the symptoms they suffer then they should be supported ti access what they need where possible.

Woman's health is quite often the lowest priority it seems, with women being expected to ensure invasive examinations and treatment without pain relief, or to simply put up with unpleasant symptoms just because 'it's natural.'

After having my daughter I went through a number of years with twice monthly pain lasting days each time, excruciating at times, making me physically sick and having to miss days of work or dragging myself in and being hardly able to function fully there. Numerous doctors, mostly male but also a couple of female ones, dismissed this as 'painful periods' (despite not actually having periods during most of the time due to the issue and 'womenswear troubles' which was all fairly normal. Probably thought I was exaggerating based on some comments.

It took one female locum to finally listen and refer me. I then ended up needing two operations, two periods of 7-8 weeks off work and months of incredibly high dosage hormone replacement ti sort the issue.

Years I waited to be listen to.

Years I could have been pain free if women medical issues weren't being so easily dismissed by doctors, and society as a whole.

We need to talk about thinks like menopause and perimenopause. The latter phrase was barely even mentioned until recently. As a healthy 50y women I feel knew very little about the menopause process until recently, now it's being spoken about more. And as I've learnt more and more things are making sense to me regarding my own health, menstrual cycle and hormone fluctuations.

It's so so important these things are being openly spoken about and that women are being given the chance to access intervention and treatment readily.

I recently attended a webinar where the doctor said that HRT is merely replacing hormones. It also has major benefits for reducing risk of osteoporosis, heart disease, strokes and dementia

For most women it actually reduces the risk of breast cancer.

People put comments like this on MN all the time but where's the proof? This sort of thing risks spreading misinformation and makes women feel like they're in the wrong for not getting hrt regardless of if they need it