"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?

Maybe, instead of trying to push all of us to be medicated against our will, it's time to actually treat people as individuals and thus accept that it's not a "one size fits all" thing? That would be progress

The chances of medical systems pushing for all women to have a medicated menopause is minimal tbh. There are hrt shortages ti start with.

What is being pushed, or at least started ti be, is an informed menopause where women can openly discuss their symptoms (and lack of them too in some cases) and not have them quickly dismissed as 'just getting older' issues.

What should be pushed is that women who do feel the need to treat unpleasant symptoms are able to have a conversation with their doctors and be given access to treatments which help support them through it, rather than the current issue of being dismissed over and over.

HRT was handed out like smarties back in the 1990s. It was not given peri menopausally or even during the menopause. For women who had ovaries removed or premature menopause it was a replacement. Then they realised that maybe they needed to look closer at whether there were risks. Taking HRT peri menopausally and during the menopause is actually increasing oestrogen levels rather than replacing them. The move towards earlier HRT prescription may well bring with it increased cancer rates and other unwanted side effects.

GPs loved it, it was the answer to their ever increasing lists of middle aged menopausal women. When the breaks were applied they had prozac to give out. But
once it was available they couldn’t slam the door.
As I have mentioned, I am part of a pretty big breast cancer support group. It is interesting how many women over 50 who are on HRT at diagnosis. I understand medical statistics so know that it is not necessarily causal, but at no point have I been asked to yellow card it.
HRT has changed dramatically since many of the studies we base our advice were done. Now most women use gel or patches. Are we basing all our risk assessments on data collected on HRT or are we aware of relative risk based on the method it is given.

www.gov.uk/drug-safety-update/hormone-replacement-therapy-hrt-further-information-on-the-known-increased-risk-of-breast-cancer-with-hrt-and-its-persistence-after-stopping

This is still on the MHRA website which issues warnings about patient safety alerts.

You can minimise the risks comparing HRT risk to a glass of wine, but no-one is asking their GP to prescribe alcohol.

I think this is a pretty good read for anyone - NICE guidelines for doctors prescribing HRT.

www.nice.org.uk/guidance/ng23/chapter/Recommendations

I genuinely don't understand you. What are you saying causes these symptoms?

Sorry Eggroll I thought I was clear.

I'm in complete favour of HT being used to alleviate the symptoms you describe.

I don't see these as 'ageing'. They are of course part of a stage of life linked with a certain age, yes.

Ageing to me is very simply getting older. There's no treatment that changes this!

So when I see suggestions that HT is being touted as a solution to 'ageing', it seems silly to me. I've no problem getting older (bearing in mind the old saying about it being better than the alternative)

The varying symptoms you describe as benefitting from HT are resulting from hormonal changes, which may or may not happen over a wide spectrum of ages.

I think it's better to separate ageing from menopausal symptoms.

I recently attended a webinar where the doctor said that HRT is merely replacing hormones.

In fact, a more accurate term is HT - hormone therapy. It's not about 'replacing' - as others have said, the balance of hormones & their requirements changes as we move through life. It is instead about taking hormones as required for optimal wellbeing.

This is what I question too

Not sure if pp is up for sharing name of Dr, it would be interesting to see if they have writing and explain what it’s based on

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.

Then I would gently suggest you have not read the BMJ paper correctly, but rather through a lens of anger or indeed rage.

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 is what one of the key messages at the bottom of the article says.

From the abstract: Changing the narrative by normalising menopause and emphasising positive or neutral aspects such as freedom from menstruation, pregnancy, and contraception, together with information about managing troublesome symptoms might empower women to manage menopause with greater confidence.

Just the very use of the word "troublesome" is as patronising as your "gentle suggestion" to be honest. Yes, I am somewhat angry at this article - because as I mentioned above, just as women are talking about this, finding out they don't have to just put up with fucking "troublesome" symptoms, someone comes along and says "narrow focus on symptoms fuels negative expectations" - so if you educate yourself about it it will all be in your mind.....

You object to troublesome

What word would you use ? Not everyone has severe symptoms- even those with milder issues should not be deterred from seeking help . But those without troublesome symptoms ( as opposed to none troublesome symptoms like periods stopping ) don't

And HRT isn't the only answer - it's part of a package of things that can help / it seems women are reluctant to admit that sometimes their own lifestyle makes things worse

And reverse placebo effect is real - seems women also don't like to admit that they are human

it seems women are reluctant to admit that sometimes their own lifestyle makes things worse

You are so uninformed it's unreal.

Their 'lifestyle' doesn't make things worse. However, eating well, exercising and trying to get good quality sleep are good choices for anyone, and even more so in one's 40s when it is more important to manage your weight & protect bone density.

Doing so will not alleviate night sweats, brain fog, anxiety, joint pain, vaginal atrophy ... if you are unfortunate to experience these & other symptoms.

I don't know why you keep posting such foolish irrelevant points.

I would say that a level of anxiety that leads to me not leaving the house alone except for the forced reason of work is more than ‘troublesome’. Life altering. Incapacitating. And since I had absolutely no idea it could be menopause related, no, it was not ‘created by my expectation of it’. Having already completed a course of cbt, no, alternative treatment of ‘this troublesome symptom’ was not really an option.

You do realise you are speaking from a stance of utter ignorance don't you? Seeing as you said you sailed through it. And I am so pleased for any woman who sailed through it. But that does not give you any insight into what "troublesome" symptoms are actually like. The word debilitating is not an exaggeration. I felt truly awful. It wasn't just a few hot flushes/nights sweats. It was everything. Heart palpitations, insomnia, anxiety, crushing, crushing exhaustion, aches and pains, brain fog, mood swings. To the extent that, although not suicidal, I really struggled with the thought of carrying on with living this way. The prospect of "freedom from menstruation/contraception" was not a light at the end of the tunnel - the tunnel was hell. Within 3 days of receiving HRT/oestrogen I felt "Normal" again. And fantastic in comparison to how I had felt. And scared when I realised quite how awful I had felt.

So yes, troublesome - I have an issue with it. A few of the symptoms, if suffered alone, I would describe as troublesome...maybe just the aching feet. Just the palpitations. Just....actually no....the rest even if alone were more than troublesome.

And the thing that got me talking to my GP about HRT? Friends who had experienced the life-giving-back experience of HRT. Not Davina (it was a couple of months before the first programme). But it was knowledge that this wasn't just "put up with it, it is your age". But a "yes, it is your age but it can be remedied".

I have never suffered from period pains. I do not have Endometriosis.. I do not feel in any way qualified to comment on whether women should just put up with period pains or symptoms of Endo. I do not feel the need to patronise anyone who suffers or complains about them. I am grateful I do not suffer from them. I empathise with anyone who may - it must be awful. I would also be angry at a medical article which said "Women who worry about getting bad period pains may experience worse period pains because of the focus on negative symptoms." Ditto other women's experiences. Endometriosis (8-10 years for a diagnosis).

Let's talk about this shit. Let's share. Let women discover excruciating period pain and flooding is not normal - see your GP, push for investigations, and yes medicalise your medical issue. Menopause adversely affecting you - yes, see your GP, get treatment to make life work living. Let's not go back to "just put up with it as it is just natural".

Well yes you would because you had signs of it

women who don’t present won’t be told and won’t know til they have it.

Hear hear

people who say ‘it was fine for me so suck it up’ are so thoughtless. Would you say that to a pregnant woman about pain relief? Such inbuilt misogyny

GPs don’t hand out hrt like sweets. They usually advise on lifestyle/health matters first. Many women on mumsnet report going to a GP and it taking a few appts, pointless blood tests and being prescribed antidepressants before hrt is discussed.

Oh and as for "it seems women are reluctant to admit that sometimes their own lifestyle makes things worse"....you know this comes across as saying menopausal symptoms are their fault? Which is fucking bullshite.

I am fit, run 30-40km a week, BMI 23, don't smoke, don't drink (well, maybe once every 8 weeks or so), rarely eat carbs. I am not sure what anyone would expect me to do to improve my lifestyle. And my symptoms were fucking awful despite all this.

I will own to the fact before I got really bad I noticed that alcohol=a nightsweat. Even now on HRT if I have more than a tiny glass of wine without drowning it with about 3 pints of water afterwards, I will get a nightsweat. So to be honest I very rarely drink. I think I have drunk something 3 times this year...it is kind of not worth it to me. So yes, your lifestyle can impact on some symptoms. But dropping the alcohol before I went on HRT (which I had done) did not relieve me of everything else.

But increases the risk of ovarian cancer .

Wait, so instead of the authors saying women should get HRT treatment if their symptoms are troublesome, you are saying they should have said women should get HRT treatment if their symptoms are debilitating?

I don’t understand why you are objecting to their saying the threshold to seek HRT treatment for women should be if their symptoms are troublesome? They’re not saying symptoms don’t ever get worse than troublesome (as yours and others do). Can’t you see that if they’d put in “debilitating” that would be discouraging so so many women from seeking HRT for troublesome symptoms? And be telling a whole cohort of women to just suck it up and get on with things?

I am really glad that the menopause is now discussed and for what Davina has done.
I feel I was completely misled about the menopause. A few years of mood swings, periods stop and everything goes back to normal hmm.

I am now on HRT - someone who never takes medication. My last period was 3 years ago and I been waiting for normality to return. In my case it never will. My GP told me this is me now. My body has deteriorated rapidly over the last two years, extremely painful skin problems, dry eyes, muscle weakness, joint pain, loss of strength, pins and needles, lack of sleep. anxiety, heart palpations, vertigo, plantar fasciitis, slow healing. The list is endless.

Indigestion and Gerda so bad I couldn't swallow at night which would be exacerbated by lack of sleep. You can die horribly from that. Linked to the menopause but mind you also HRT - presumably because of progesterone interaction with gut. Not enough research yet. Hopefully the HRT progesterone will help it, so far it has. It can't be worse.
I was blood tested and I was referred to the hospital about pins and needles arm pain etc Everything came back normal.
GP then tested me for menopause which of course I am. After a lot of deliberation I am on HRT. Some immediate improvements eg indigestion, energy, skin probs calming down -some more time is needed to see. But part of me is already back thank God.

The person who said that you don't live healthy therefore you get the menopause worse. I was as fit as a flea with no previous ailments or troubles at all. Sadly I wont be able to tell some people I am on HRT because they will think I failed or I'm avoiding ageing or some other crap. They have no idea.

I think you are taking the article too personally. They are talking about population level statistics, not you. So yes obviously for some women like you lifestyle did not prevent severe menopause symptoms, but that doesn’t make it “fucking bullshit” when they’ve done studies on thousands of women and found that there is a correlation between several lifestyle factors and the severity of menopause symptoms. And it’s not saying it’s anyones fault per se, just educating women on real risk factors that they can avoid by changing their lifestyle. Isn’t that what we want? For women to be educated on menopause? For studies to be done on menopause?

There’s no proof iHRT reduces the risk of dementia. Here’s what Alzheimers UK says about it.

Hormone replacement therapy

Some women choose to have hormone replacement therapy (HRT) when they go through menopause to help relieve some of the more unpleasant symptoms, such as hot flushes and mood swings. HRT is usually a combination of oestrogen and another hormone called progesterone, although there are different types.

Studies looking at whether replenishing oestrogen levels using HRT can reduce women's risk of dementia have been inconclusive and contradictory. For example, some studies of women who were already using HRT during menopause found that their risk of dementia was lower than those not on HRT. However, other studies found no strong evidence for this. There is some evidence that HRT may even increase dementia risk. Clinical trials looking at the use of HRT to treat Alzheimer's disease in women, rather than prevent it, did not show any beneficial effects on cognition.

Until there is better evidence, the potential benefits of HRT as a way to reduce the risk of Alzheimer's disease do not outweigh the potential risks of HRT, which includes an increased risk of certain types of cancer, heart disease and stroke.

Hormones may still provide a way to treat or prevent dementia though. Researchers continue to look for other hormones, and other ways of using oestrogen, which could be safer and more effective. More research into why women are more likely to get dementia than men is also important to help us understand exactly what causes it.

It all boils down to risk assessment. HRT can and does increase the risk of breast and other cancers for a few women. I did the maths and chose to take HRT. Unfortunately, I am one of the handful.
I was happy to have the Covid vaccination despite unknown long term risks.
I chose to have radiotherapy despite a small risk of developing leukaemia long term.
All these choice were informed, discussed at length and I have no beef with the NHS or medics who helped me make those choices.
But I did the research some years ago, not influenced by the likes of Davina McCall. The media seem to hell bent on pushing all women to push for HRT when statistically this may be a bad move for them.
I would like to see a balanced argument that doesn’t involve influencer type methods and evangelical messages.
The menopause is pretty shit and I’m glad that I had HRT to help me through it. I don’t regret taking it since it made the last 5 yrs doable. But I am glad that I’m now off it. I can report from the other side that it is fine. Post menopause is just like pre menopause without periods. I’m nearly sixty so I expect to ache a bit but at least now I can sort of leap out of bed. During peri and menopause it took me 5 minutes of stretching and a couple of paracetamol to get going even with HRT.

Ovarian cancer? Some hrt is meant to protect against ovarian cancer. Not sure where you got your info.

www.cancerresearchuk.org/about-cancer/causes-of-cancer/hormones-and-cancer/does-hormone-replacement-therapy-increase-cancer-risk