"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?

This was published in the BMJ Editorials (so not a study, but a summary) five days ago:

Looking at HRT in perspective www.bmj.com/content/377/bmj.o1425

“HRT may help relieve short term cognitive symptoms related to the menopause, but this should be clearly differentiated from dementia prevention. Evidence does not support use of HRT to reduce the risk of dementia. 1, 2, 4 , 6 ,7 “

1. National Institute for Health and Care Excellence. Menopause: diagnosis and management.NICE, 2015.
2. Hamoda H, Panay N, Pedder H, Arya R, Savvas M. The British Menopause Society & Women’s Health Concern 2020 recommendations on hormone replacement therapy in menopausal women. Post Reprod Health2020;26:181-209. doi:10.1177/2053369120957514. pmid:33045914

4.Baber RJ, Panay N, Fenton A, IMS Writing Group. 2016 IMS recommendations on women’s midlife health and menopause hormone therapy. Climacteric2016;19:109-50. 6.Shumaker SA, Legault C, Kuller L, et al., Women’s Health Initiative Memory Study. Conjugated equine estrogens and incidence of probable dementia and mild cognitive impairment in postmenopausal women: Women’s Health Initiative Memory Study. JAMA2004;291:2947-58. 7.Henderson VW, St John JA, Hodis HN, et al. Cognitive effects of estradiol after menopause: A randomized trial of the timing hypothesis. Neurology2016;87:699-708.

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…

so various scientists and experts in the field, around the world, can’t come to a conclusion on HRT and risks/benefits.

but a lay person can do a bit of googling, read a couple of articles and somehow reach conclusions the scientific community can’t?

this “do your own research” is crap. It’s a line people trot out when they actually can’t back their own opinions up- and of course they can’t, it would take a full time masters or phd just to reach a level informed enough to know what research has or hasn’t been done, and whether that is meaningful.

@Reallyreallyborednow That was my point though 🙄.

There is no consensus in the world of science. So personally I have found it helpful to do lots of reading via various sources (not Google). Then I apply what I’ve found to my own situation. I’ve had breast cancer so I have had to read up far more on this. Not just a bit of Googling. I wouldn’t take a risk with my life based on Google.

Many books on this do draw upon various studies and go through the drawbacks of each study. The book I’ve mentioned goes through about 20+ studies for you, it’s very informative.

It’s your choice. Yes it’s very confusing out there but I don’t see how being informed and doing lots of research and talking to experts in the field is ‘crap’. Don’t do it if you don’t want to.

And really there very rarely is consensus in the scientific community. I wouldn’t use that as a reason not to take something that could be very helpful and protective against diseases in later life. Once I’ve done my own research. Which to be honest, I’m still doing. But despite having a hormone positive breast cancer I am leaning towards taking it based on everything I’ve read so far. Make of that what you will. Personal
choice.

If you are waiting for a consensus on HRT you’ll be waiting forever.

@ancientgran Men do produce small amounts of oestrogen but also continue to produce Testosterone all their lives. Testosterone is converted to oestrogen inside the brain which means men continue to produce oestrogen and therefore women have lower levels than men post menopause. All according to the Alzheimer’s Society.

It is all so complex but my point is I wouldn’t base my decision on one study or one source.

I’m a bit baffled by the dementia argument as linked to menopause. Average age of menopause is 51, but rates of dementia in men and women are the same until after age 80. That’s almost 30yrs after oestrogen levels taper off…so it seems odd to me that if lower oestrogen does cause dementia that it would take 30yrs to take effect? This study suggested
”Women’s survival to longer ages may be one explanation for women’s higher incidence of dementia and AD, possibly. Other explanations may be etiological differences, selective attrition of men due to early mortality attributable to cardiovascular risk factors with a competing risk of death or dementia, and lower thresholds of disease pathology required to produce symptoms” (AD= Alzheimer’s subtype of dementia)
www.ncbi.nlm.nih.gov/pmc/articles/PMC6226313/

But women, whose baseline starts off much higher than men, also continue to produce estrogen after the menopause.

It’s from the Alzheimer’s Society page where it is all explained. I’m guessing they wouldn’t put information out there that isn’t correct, as they are supposed to be the experts.

They say, as men continue to produce testosterone which is converted to oestrogen then they have higher levels of oestrogen than women of the same age that have been through menopause.

To be honest, this is all news to me. I had no idea men even produced oestrogen.

I’ve attached to page again. I guess it’s all very complex. But I would assume and hope The Alzheimer’s Society we’re not publishing glade info and everything is checked by scientists.

False info

I don't expect the Alzheimer's Society to be leading expert's in women's hormones. It was only discovered in relatively recent years that women's ovaries continue to produce estrogen, albeit in smaller amounts, post-menopause.

The adrenal glands, post-menopause, also provide estrogen - they produce a hormone called androstenedione, which can covert to a potent estrogen, estrone.

Androstenedione is also converted into testosterone and in turn, testosterone can undergo a process to convert into another form of oestrogen, estradiol.

All that said, the ranges of estrogens in men and women in later life varies, so it is really impossible to say flatly that men have more estrogen than women; some may, and many may not.

I thought men produced less testosterone as they aged? It is all so confusing but then I've still got covid brain fog so maybe it's just me.

I don't expect the Alzheimer's Society to be leading expert's in women's hormones.

Fair enough. I expect them to be experts on dementia though. 🤷‍♀️

I’d assume the Alzheimer’s Society would be experts on dementia and its causes and would check any information they publish carefully.

Is this going to be one of those threads where Mumsnetters know more than the experts in this area?

The Alzheimer’s Society has this to say about HRT and Dementia:

”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.”
www.alzheimers.org.uk/about-dementia/risk-factors-and-prevention/hormones-and-dementia

I doubt it. It seems to be a case of HRT evangelists thinking they know more than experts.

There is a theory that women who get hot flushes will be more prone to dementia and those women would see a double benefit from hrt - relief from symptoms and protection from future brain problems caused by brain heat

Yes that’s what they have to say on HRT and Alzheimers as there is no conclusive evidence to support the use in this regard.

However the page I linked to was information with regards to why they think Alzheimers affects women more than men and the role of oestrogen. More of a discussion on what the current leading theories are.

I would in no way expect them to be recommending HRT as a preventative cure for dementia as it’s not their remit.

I would in no way expect them to be recommending HRT as a preventative cure for dementia as it’s not their remit

Then what is their remit? They’re called Alzheimer’s UK. If there was definitive evidence, they’d publish it, it’s literally what they’re for.

We’ve established there’s lots of conflicting studies. So they can’t recommend anything with regards to HRT.

Brain heat!

Women get more dementia than men

Women get more dementia than men

Exactly. So what’s your answer to If dementia is linked to lack of oestrogen why don't men have it more than women?

Women get more dementia than men

Women live longer than men.

This doesn’t cover hrt as a preventative.

This research is based on those already with Alzheimer’s.

we really need a lot more research on all this and fast

This doesn’t cover hrt as a preventative.

Yes, it does.

This research is based on those already with Alzheimer’s.

No, it isn't.