"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?

There are so many women who seem to think it's a mild case of hot flushes etc whereas as others have pointed out fluctuations of hormone levels can cause numerous intense bodily reactions. Nearly 20 years ago when I was starting peri menopause I had a suspected TIA which when investigated ended up as being diagnosed as hormonal migraine which mimics a stroke. This was the beginning of other issues - inability to sleep due to pains in hips and thighs , increased heart rate, anxiety, panic attacks, drooping bladder etc. I have been on HRT for 10 years in total now. As my male GP said after all it is about quality of life - the life that you have now.

I had a look at the link thanks. That’s so frustrating from Cancer research as it doesn’t break it down into peri/meno, cover type of hrt or what age group the research is based on. Recent coverage of this topic indicates that hrt (like the pill) might be protective of ovarian cancer. This sort of blanket statement will put some women off taking hrt when for them as individuals it might be just fine and beneficial.

The link points out the relative risk compared to alcohol and smoking - much much higher.

Lots of things are "normal" and "natural".

Childbirth is a good comparative example. Very normal. Very natural. Killed millions of women before "medicalisation". And now people are horrified (quite rightly) by a trend of "free birthing".

Just because menopause is "natural" doesn't mean we shouldn't try to improve the lives of women negatively affected by it if we have the "technology" to do so. And if we can mitigate the risk of poor health outcomes for women such as osteoporosis, dementia, Alzheimer's it makes complete sense to do that. Not only for those individuals but in terms of reducing the cost and impact of treating those conditions on our health service.

Obviously like all medical treatment it should be a choice (and NO ONE is saying HRT should be forced on all women despite what some PPs have said) but it seems a no brainer for HRT to be readily available to women who want it.

I'm 43, been having symptoms of menopause since about 36 without any help. Recently my periods stopped. I spoke to a female dr who was determined to find out why they had stopped. I had loads of bloods, she spoke to gynacology and endocrinology about my results and finally was diagnosed as going through menopause (tho my hormone results suggest I'm post menopausal)
As I'm 43 one of my main concerns is osteoporosis and I know hrt can stop it so decided on hrt. Its also helped with the sweats etc but I think at my age its not over medicating to try and stop my bones becoming weak. When I get to my 50s ill reconsider then.

Dementia bothered me to.
I'm really not a fan of having to pump the hormones into my body but realise I need them.

Oh fuck them. HRT has saved my bacon, and they’ll have to hold me down and peel that patch off my arse.

Typical. We start to stand up for ourselves and articulate what we want and we’re told to shut up and suffer our female burden.

I reiterate. Fuck them.

It’s worse when it’s other women coming out with this crap.

For years nobody had even heard of peri menopause or understood the whole process of the menopause. And the impact it can have on many women. It was very much put up and shut up.

My poor Mum went through an early menopause at 40 and was made to feel like she was losing the plot for years. She suffered so much unnecessarily, very unsympathetic doctors. She repeatedly came back from the GP in tears. We want to go back to that do we? Finally we have choices- yes choices, you don’t have to have HRT if you don’t want it. You won’t be held down and forced to wear a patch.

But when symptoms are minimised, or women are blamed for making symptoms worse through lifestyle choices- by other women! I mean wtf? This site at its very worse.

We all need more knowledge and research on this. Not less! I’ve had to do extensive research as I’ve had breast cancer so it’s really important I look at every single study. From what I’ve read I would be happy to take it. Because for every 20 studies that are positive it’s always just the one negative (and usually poorly run study- see the HABITS study) that makes the headline news and has people throwing away medication that can help them.

It’s a minefield out there and the government websites and NICE guidelines are typically outdated.

For those that are interested- I mentioned it before but the book ‘Oestrogen Matters’ is written by an Oncologist whose wife had breast cancer and he was happy for her to take HRT. And he spent years going through hundreds of studies on this. I’d highly recommend. My (very knowledgeable) GP has also read and recommends this book.

Dementia bothered me to. I'm really not a fan of having to pump the hormones into my body but realise I need them

Dementia is endemic in my mum’s family, I’m pretty much resigned to getting it if I live long enough. However, given the lack of evidence that HRT protects from it - and Alzheimer’s UK makes that clear - I’m not prepared to take it just in case.

I wish the research was clearer specifically about the relationship between the different types of HRT and the different types of dementia - I hope that research is happening now. It's huge in my family background too, and I would be prepared to take it just in case if there was enough evidence that it was likely to help, even if there were some other small risks as well. But at the moment, it doesn't seem to be known that it will help at all, let alone enough to make the other risks worth it.

You are asking for the impossible there. They struggle with the various types of dementia and the how and the why without linking it to anything else. My mother died with early onset dementia (no HRT) .HRT has not been in use for years and years - I think I read that maximum years is about 30 for research purposes?
In 1900 the average life span for a woman was 50 years. The average now is about 82 years. Many years of living without vital hormones for some. People have to make their own choice.

Oh I know it will be impossible to get 100% conclusions. But i still hope the research is going on, looking more fully into it, and I don't think that's too much to ask. Of course people ahve to make their own choice, but the better information we have to do it with, the better. I am terrified of dementia, and would take HRT if I thought there might be some protective factor. But it's not clear enough at this stage. So many different kinds of HRT, so many kinds of Alzheimers (I have the familial kind in my family), etc., and I'd like to find out what I can, but the research is not easy to come by or interpret.

BotCross you’re right and make good points.

It would be useful for women to know more so they can make better decisions, but also in a broader sense there could be cost savings and benefits on a societal level.

This is interesting. www.bmj.com/content/374/bmj.n2182

Particularly this bit

This study gives estimates for risks of developing dementia and Alzheimer’s disease in women exposed to different types of menopausal hormone therapy for different durations and has shown no increased risks of developing dementia overall. It has shown a slightly increased risk of developing Alzheimer’s disease among long term users of oestrogen-progestogen therapies.

It would be great if things were clearer. Unfortunately, the sort of large-scale longitudinal studies necessary cost millions of dollars/pounds, and are unlikely to be re-mounted after the (now disputed) results of the WHI studies (which cost in the realm of $625 million dollars), or the Million Women Study.

I think individual women need to weigh up their own risk/benefit re HRT or not, and obviously discuss with an informed GP or menopause specialist. Or read (more than one book), exercise google, etc, if those can't be found nearby.

It is odd people are saying they've not heard of peri-menopause - I read a book discussing it nearly 25 years ago. If you were ignoring this phase of life (in denial, not interested in something 'in the distant future", etc) then it is likely you paid no attention, but there have been books discussing the menopause, and books advocating for or against HRT, since at least the 1960s!

As to how hard the menopause will be may depend upon how fully stretched we are in our life context. A high pressure full time job or several children still at home or keeping an eye on aging parents an unsupportive husband or being a single parent or not enough income are just a few examples.

That said one in four women have no menopausal symptoms whatsoever! How fortunate these women are.....

'It has shown a slightly increased risk of developing Alzheimer’s disease among long term users of oestrogen-progestogen therapies.'

This is quite staggering tbh. When we hear repeatedly on the menopause boards and Davina docs that it 'protects against dementia'. No, it doesn't. Apparently the opposite even of only a slight increased risk.

Hi I wrote a post about this. Brain scanning is expensive and rare. Hence not enough research data - yet. Neuroscientists however are pretty clear hormone loss is linked with dementia. Which is why peri/meno women get brain fog and memory loss. Early signs of serious matters.

And yet more women than men get dementia at all ages.

'And yet more women than men get dementia at all ages.'

Yes with a slight increase in those taking hrt.

I'm all for taking hrt if women are fully informed, if they know it increases the risk no matter how slightly of serious illness. If the effects of reduced oestrogen are disrupting their lives significantly it will then be a risk worth taking but the narrative that it prevents against dementia needs to stop as it just isn't true.

Neuroscientists however are pretty clear hormone loss is linked with dementia. Which is why peri/meno women get brain fog and memory loss. Early signs of serious matters

can you post links to back this up please?

why aren’t organisations like alzheimers UK publishing this? They seem pretty clear there’s not enough evidence, and the research I’ve seen would back this up.

The problem is the studies quite often come to different conclusions.

You can have 20 saying one thing - for example HRT is beneficial for dementia- and 1 says it’s not. You post the one that says it’s not and everyone takes that as gospel.

The Alzheimer’s Society does say dementia could be linked to a lack of oestrogen see attached. It they don’t have the conclusive studies yet. We may never have.

You really need to do your own research rather than focus on one study. Read as many as possible. Read the criticisms of the studies…

I would think that one thing that makes it difficult to get definitive answers is that dementia isn't caused by just one condition. There are various causes of dementia and some we know the cause of Korsakoff's for example is generally linked to alcohol abuse or vascular dementia which is to do with oxygen not reaching the brain.

Maybe HRT can protect against one type but not another? That might make results hard to interpret but I suppose the answer is separate studies for each type of dementia which might be hard as there are so many types and then you get people like my elderly relative with advanced dementia which has never been diagnosed as a specific type of dementia and is recorded as Atypical presentation dementia.

If dementia is linked to lack of oestrogen why don't men have it more than women? Is something else protecting men?

I agree with you and other considerations are that dementia is usually diagnosed in much the same way as menopause - by observation so is hardly accurate. For accuracy you need an autopsy. There are tests that can be done while alive but when you have a patient refusing to have them then you are stuck. By the time death occurs few families can face an autopsy. People tend to lump dementia into one thing when it is far from it.

www.ncbi.nlm.nih.gov/pmc/articles/PMC6390276/

www.bbc.com/future/article/20180705-why-dementia-and-alzheimers-affect-women-more-than-men

www.alzheimers.org.uk/blog/why-dementia-different-women

These are just a few.