BBC1, 8PM Tomorrow (Monday 30/9). Panorama - The Menopause Industry.

[SebastianFlytesTrousers]

Documentary presented by Kirsty Wark investigating the multi million pound global menopause industry.

Should be interesting.

This exactly. I think we are already at the US model by hook or crook for those that have insurance or pay at point of need bc no other choice. And if no funds you struggle on and it's dire.

I am currently looking at switching to private care for perimenopausal issues due to the poor care I've had from my GP who is very anti HRT and tells me how I will need to come off it asap and that if I go to a higher dose I will only feel worse when I have to stop, I am not even 50 yet and she gives me so much grief about being on HRT and is obviously against it personally. On the other hand she is happy to try and push SSRI's on me which have also been linked to increased breast cancer risk when I am not depressed I have hot flushes and night sweats that mean I can't sleep and then I am unable to cope with my work and various caring responsibilities, HRT fixes these issues.

Ideally all women should be able to get good quality care for their menopause from their GP but sadly many GP's are clueless so people like Louise Newson will continue to provide an important service. I do think there is a bit of vendetta against doctors like her operating outside of the NHS, I feel like often GP's treat you like you are an idiot, they assume you just want a pill to make all your problems go away and they don't even want to hear all the various lifestyle changes you've made to try and improve things. My GP has an attitude that I am just being a bit silly and am scared of getting old and so want HRT and that I should just take an anti-depressant.

I also seem to remember that the pill also comes with fairly serious risks and yet since I have been a teenager doctors have always been trying to get me to go on the pill or have a contraceptive injection or implant at various points.

It seems to be there is a major knowledge gap for many GP's and it would be great if all practices had at least one Dr who was properly educated on the menopause and how to treat it.

SSRIs not linked to breast cancer

Where is the evidence to suggest SSRIs have been linked to BC please?

If you google it you will see the studies.

We have to be careful not to scaremonger here.

Indeed. As one who has been offered SSRI medication because HRT isn't an option, I'm now thinking there's literally nothing out there to help me.

Maybe getting paid more to dole out the SSRIs? That would explain a lot!

https://www.komen.org/breast-cancer/risk-factor/table/

Some people might find this interesting.

No evidence to support antidepressant use as a breast cancer risk factor.

Dr Lisa Mosconi has a very interesting podcast on her work on menopause. The impact on the brain (her team were the first to scan female brains pre & post menopause) is fascinating. Menopause is as much a brain as a hormonal issue

Here's an open access study from last year saying not and there was another study published this year

'Large MR analysis showed that antidepressants as well as SSRI drugs were not associated with breast cancer risk and the SSRI-prolactin-breast cancer hypothesis did not hold in our analysis.'

link.springer.com/article/10.1007/s10552-023-01766-z
Niu, D., Li, C., Yan, X. et al. The relationship between antidepressants and breast cancer: evidence from Mendelian randomization. Cancer Causes Control 35, 55–62 (2024). doi.org/10.1007/s10552-023-01766-

GPs cannot be experts on everything and I don't think the public appreciate the time commitment of ongoing training. My Newson Health course took many hours over several months (in addition to working) and ongoing input with peer support and discussion of complex cases.

It is idiotic to suggest all GPs should become experts in menopause as the only way it could happen is at the expense of other ailments, many of which are life-threatening. Having said that they should all have a basic knowledge and the humility to ask advice or refer on if they do not

I am not surprised that LN has had huge numbers of supporting posts online as she has developed a cult-like following. One of the things I hated when running the menopause clinic was when women came to us ready to be aggressive because they had been brainwashed by her and others online to think all GPs were useless and would fob off HRT requests. They were often genuinely surprised when told our practice had a menopause clinic and we would support patients with lifestyle advice, non-hormonal treatments or HRT according to their preferences (wherever possible). I do think some were almost disappointed they didn't get the fight they expected!

@Newmum738 If you are in the UK how, exactly, do you think GPs would be paid for "doling out" SSRIs? That is absolute nonsense, the NHS monitors and maintains really strict control of prescribing and budgets

@JinglingSpringbells While I agree many people are out of touch with private medical costs, you have to realise the prescribers at Newson are not medical consultants; some are GPs and many are pharmacists or nurses so not comparable to most of the private medical system

@timidviper Brilliant post!

@timidviper GPs could have some awareness at least. We've had awareness sessions at work and if we hadn't I would be in despair, not knowing what was wrong with me and unable to get the right help. Id settle for any NHS facility with some knowledge. That could be a helpline or one GP per practice. It isn't unreasonable for a condition that is guaranteed to affect 51% of the population.

As for products, the sales reps visit the practices to get them on board with their products. Never more obvious than when I was pregnant and they were so desperate to get me to switch from Rennies to Gaviscon, they gave me some for free. I can't stand the stuff and stuck to my rennies.

To be fair though, and there's never any excuse for lack of knowledge from GPs, although 51% of people will go through menopause, not everyone is going to need to seek medical help.

I don't think they necessarily have been proven to be a waste of time and money - but they haven't been proven to be effective. Not the same.

There are still arguments around what we need and what we don't (and of course all that research is done on men!) but it's never a waste of time to take vitamin D, for example.

No, but I wonder how many more women would if access to GPs was available easily.

Even nurse or PA led care would be a huge improvement for a lot of women, and for example, they could deal with the repeat prescription requests and refer anything they were unhappy with.

I do think there's a level of sexism and ageism with this whole thing. Women are meant to put up with "womens' thing" (even in maternity, but at least then they are producing future tax-payers and baby-incubators, so men can see some advantage to helping them, though that is woeful as well). Other women think they should as well - see all the arguments about having c-sections or daring to have epidurals. Or women who have easy periods being seemingly incapable to realising that not everyone is like them.

But once you are menopausal you are of no further use to society (other than to care for grandchildren or volunteer) so why are you even moaning about hormones, just get on with it.

I think most nutritionists will tell you supplements are a waste of time and money and you should be able to get everything from your diet (apart from vitamin D). This is partly true if you have the absolute perfect diet.

I feel like certain ones help me and I’ll continue to take them. The point is there’s no studies done on how effective they are on menopausal symptoms. Just because there’s no studies doesn’t mean they can’t help individuals.

Magensium glycinate is helpful for sleep - it certainly helps me. As does L-theanine.

I find ashwaghanda helpful for stress and holy basil is calming. These are herbs that have been used for centuries in eastern medicine. Don’t forget HRT is often made from yams.

By all means be careful about what you spend your money on and try and get as much from your diet. But I’m not getting adaptogen herbs from my diet!

If you examine the conclusions to her studies so far, she says that the brain largely adjusts by the time post menopause is reached. There is actually then an increase in grey matter. Let's be careful here - there are women here who can't take HRT and we don't want to scare anyone.

@SebastianFlytesTrousers , thank you for a positive post .

@SebastianFlytesTrousers Dr Mosconi makes it clear that not all women are affected.

Based on the lived experiences outlined on this thread, facts re menopause in the medical community seem to be thin on the ground in some areas. Many women complain of brain fog as a symptom and now for the first time we are seeing evidence of the cause. I don't see the benefit in hiding research so as not to "scare people" - I think women might like to know it's not "all in their heads" (irony intentional!). I certainly think this should be required training for GPs.

@Newmum738 Where are you working, the 1970s? It has been illegal for doctors and their practices to accept gifts from pharma for many years, not even Biros! If that is recent you should report it. I also doubt a rep promoting Gaviscon is recent as most practices switched to more cost-effective versions like Peptac years ago.
Reps are allowed into our practice to provide educational information only and by arrangement only (so, if we are aware we need to know more about a new drug we may allow one in but it's not like the old days where they would just call in bringing pens and Post-its, etc)
The only primary care influence on prescribing is usually the local ICB (aka CCG, PCT, etc) which may have local initiatives to improve prescribing but they are generally things like ensuring prescribing is cost-effective and evidence based, never anything like don't use HRT as social media suggests.

The practice I worked in had a trained menopause clinician running a clinic weekly and 2 GPs with knowledge of women's health so they do exist and this was in a deprived area, not London or leafy Home Counties!
I agree women should not be pushed to other medications in place of HRT but we now see many cases of women who, under the influence of Newson et al, insist on HRT, thinking it will cure all, and are devastated when their symptoms persist. Prescribing HRT based on ticking a list of symptoms runs the risk of missing many clinical conditions

@SebastianFlytesTrousers A couple of years back LN posted a "study suggests HRT prevents dementia" type social media post, having rubbished a very similar study which suggested the opposite only a couple of months earlier. I questioned this on the post but got no reply so asked, on Lisa Mosconi's page, if this was an accurate interpretation and got a PM back saying "Let me guess, is this a well known UK menopause expert saying this? I will look into it"
Lisa Mosconi has also stated very openly that healthy diet and lifestyle reduces dementia risk by a huge amount (I think 40-50%) which is far more than any medical intervention

@sharpclawedkitten I'm not talking about vitamin supplements, more the supplements which are aimed specifically for menopause ( which appear to just be a combination of vitamins?)

No idea, it's a minefield.

@timidviper I was pregnant in 2018 and I can assure you they were desperate for me to have Gaviscon so they prescribed it which is free where I am. And the reps do go and push their products to the go surgeries so make of that what you will!

I dare you to ask the next rep that comes in or one of the GP partners if there is any law relating to this!
Maybe some areas are hotter than others but we are behind the barricades to reps now