"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?

Online test for risk factors for osteoporosis:

healthybonesaustralia.org.au/your-bone-health/risk-factors/

More detail about risk factors:

www.osteoporosis.foundation/patients/about-osteoporosis/risk-factors

I have asked in social media threads for the studies to back up the posts and have never had a response.

it is interesting that she quotes another expert as supporting "HRT prevents dementia" yet that person replied to a query that the evidence is not there yet as years of research are needed yet

NICE guidelines 🤣 I work under NICE guidelines, in order to apply them effectively you would need an hour or more with every patient. It’s just not possible to cover every point in the 10mins GPs have. They are a tick box exercise at best. When I was prescribed HRT the GP wrote out the prescription.
I suspect that as there is a shortage of HRT currently HPs have been swamped with requests ( I read there has been a 30% increase in prescriptions). Perhaps that’s why everyone else is struggling to get an appoint with their GP at the moment.
I would like to think everyone who is being prescribed HRT is being fully evaluated but worry that there will be long term problems.
Patients are notorious for withholding information if they think they won’t receive the treatment they want.

I fully understand the OP’s fears but not everyone has a difficult menopause, not everyone sees improvement, not everyone’s symptoms are down to the menopause and not everyone will be advised to take it. [HRT]

The menopause is not a life limiting or life long disease, it is a natural phase of life. Stringent screening should be undertaken to assess the benefit for every woman who requests it. This should include a full family history to look at risk of osteoporosis and a bone scan carried out to measure bone density at the point HRT starts. Further testing after five years will indicate whether it is effective for each woman. If not, other medication is available.

Women should be aware of the increased risk of certain cancers when extending exposure to oestrogen and also the fact that the risk does not necessarily reduce if you stop HRT.

I really like what you've pointed out here, Angrymum. Quoted for truth.

www.thelancet.com/journals/landia/article/PIIS2213-8587(22)00142-5/fulltext

this is an interesting article in the lancet about meno treatment and perhaps the UNDER medicalisation - they focus on heart and bone health.

It certainly highlights the need for more extensive mid to later life screening and education on prevention to encourage more women to make lifestyle changes earlier to reduce CVD risk and prevent a reduction in BMD.

We have to be careful interpreting the results of this type of article which primarily studies American women who have different lifestyle and health provision. Metabolic diseases ( cardiac, diabetes etc) have multiple causes and a lot of work is currently being done on genetic causes which may also influence menopause. Endocrinology is not simple and adding back in female hormones may have many not so beneficial effects.
Many who men who suffer from unexplained infertility probably have slight imbalances of hormones that are missed because blood testing does not look at the complete picture but rather a collection of hormone levels that are within the normal ranges but together may not support pregnancy.
In a similar way how we react to lowering levels of hormones is different individually.
I had oncotype testing to determine whether chemo would be effective for treating my breast cancer. It measures the type and quantity of a number of genes found in breast cancer tumours. The presence of a combination of genes can indicate whether the tumour is likely to spread.
I think we need to be channeling funds into tests to see if bone density is actually directly effected by reducing levels of oestrogen or whether it is a result of one of the many other chemicals associated with oestrogen so we can tailor preventive treatment and lower the risks associated with oestrogen.

Sorry I meant to add that the oncotype test and a number of similar tests have a data base including over a million women whose disease course continues to be charted. I think they now have close to 10yrs of data. This means the tests are becoming more and more accurate at determining who is likely to develop remote recurring tumours ( secondaries).
It is actively reducing the number of women receiving unnecessary treatment and improving their long term quality of life.
Chemo is not like taking a course of antibiotics it may stop you developing secondary tumours but it can leave you with life long disabilities.