Janice Turner on the Menopause Industry

[Hagiography]

A thoughtful and timely article.

www.thetimes.co.uk/article/menopause-industry-is-misleading-women-mpmh29p08

www.bmj.com/content/377/bmj-2021-069369/rr

Newson has responded to a BMJ article that I think triggered the Turner article. List of signatories at the end.

Rapid Response:
Re: Normalising menopause

Dear Editor
We are appalled and quite frankly saddened to read this article that is peddling a very dangerous narrative – that because menopause is a ‘natural’ part of the ageing process, that women should avoid any medical treatments. The core of the problem is women’s choice. For too long women have not being listened to, they have been undermined and belittled, they are being told to put up with symptoms that can lead to women leaving their jobs, partners and suffering with horrendous symptoms affecting their quality of lives. The menopause is known to be associated with an increased risk of important diseases including heart disease, diabetes, clinical depression, osteoporosis, dementia and early death. Also for many women the menopause is not “natural” as it occurs due to surgery to remove ovaries or damage to the ovaries from drugs or radiotherapy. Many young women experience menopause which is known to be associated with an even greater risk of developing these diseases.
It is vital that the menopause is recognised as a female hormone deficiency with health risks and not simply a lifestyle change that doesn’t need medication. Menopause care should be holistic – HRT is not the only treatment we give as menopause specialists, we also give nutrition, lifestyle, exercise, wellbeing, psychological advice – but the fundamental thing that women should be offered is choice. If we want to promote choice, we have to start with the ingrained misconceptions and prejudices that surrounds women’s health.
Just because something occurs ‘naturally’ doesn’t make it good. This is a version of the naturalistic fallacy, applied to over a billion menopausal women worldwide.
We often see the same thing in the objection to ‘medicalising birth’. Yes pregnancy is a beautiful natural process, but helping women have safe pregnancies is not medicalising their experience, it reduces their risk and improves outcomes for babies and mothers.
It’s not a coincidence that the medicalising charge is directed against women both when pregnant and when menopausal. Society seems to have a hard time accepting that women are embodied, they are not ethereal beings, that they have medical needs which have to be addressed, funded and provided to ensure equity and ease of access. There is now a generation of women standing up and demanding change. Telling them what they’re experiencing is just normal part of ageing is frankly medical gaslighting.
There is a national HRT shortage as more women are requesting HRT. We have clearly reached a crisis point as the demand by women to receive evidence based treatments has escalated.
Many healthcare professionals are still confused, understandably, about evidence-based menopause care and treatments, including safe HRT prescribing, because there have been so many confusing articles in the medical literature and inadequate menopause education for many. We have already had over 25,000 downloads of our free Confidence in the Menopause education course which was developed by the not-for-profit company, Newson Health Research and Education. This highlights that so many healthcare professionals are keen to learn more which is going to really help improve the future health of women and reduce their suffering.
It is essential that all educators are consistent in their messaging and refer to the recent evidence and research which clearly show that the health benefits of taking HRT are very real and apparent. We certainly are not stating that all women should be forced to take HRT but all women who want to take HRT should be allowed to have it in a very easy and accessible way. They should not have to be fighting to have their own hormones replaced.
Competing interests: Dr Louise Newson is Founder of Newson Health Menopause Society and Director of Newson Health Menopause and Wellbeing Centre. Since opening her menopause clinic in 2018 she has received no money from pharmaceutical companies. She created the not-for-profit company Newson health research and education in 2019. The society was launched last year. We do not do any paid work with any pharmaceutical companies. In addition, our society receives no money from pharmaceutical companies. All the people contributing to this response are associates of the society and have no competing interests.
16 June 2022

Sorry it's lost it's paras!

Re that letter I thought studies on dementia were mixed? Is it now accepted by medical body that it’s the case that it will lower it.

And this - It is vital that the menopause is recognised as a female hormone deficiency with health risks and not simply a lifestyle change that doesn’t need medication.

Are we accepting deficiency as the standard language?

I’m glad women are more informed and have better access but would like to hear from outside the clinic too

thanks for this. Is there a refreshed token any where, please?

Yes we’ve been over it in this thread: there is no evidence that HRT protects against dementia. There are studies showing improved cognitive functioning in women once they go on HRT but these are short term gains (ie eliminating brain fog), and should not be confused with evidence of protection against dementia.

I don’t agree that menopause = hormone deficiency. You can only think that if you think the hormone levels we have during fertile years are the baseline for our entire lives. This doesn’t really make sense to me on a basic physiological level. I agree if you have early/surgical menopause then you would have a hormone deficiency up to the average age of menopause. But for the average woman at menopause age, I don’t see it that way. By framing it as a deficiency though it means you can push HRT on every woman and make more £££ as a private menopause specialist.

It is vital that the menopause is recognised as a female hormone deficiency with health risks and not simply a lifestyle change that doesn’t need medication.

I think that's a hugely contentious statement to make. Agree with Discovereads above.

Also, I find Newson's statement on competing interests about pharmaceuticals is slightly disingenuous - she makes money from treating women with HRT, from charging for care.

Thanks Discover both really important points

I think they highlight the extent to which Newson is speaking as a marketeer for her services, yes it’s good awareness is raised but there needs to be care with any claims made

If you compare to NHS guidelines you know each word is carefully considered and backed up by a lot of information

That no money comes from pharma is irrelevant to me, it’s a private clinic offering consultations - that’s the £ part

It is a deficiency in hormones. Or a decline or a reduction. Whatever you want to call it. It’s the same meaning to the average Joe public.

It’s all about choice. I had to beg my GP for HRT and still ended up going into debt to see a private consultant. I’m not sure I would still be in full time work without HRT. And I fit and heathy etc etc so it was a complete which to finally realise that I was menopausal. I seemed to miss peri by not understanding or knowing - yet certainly I suffered and so did those around me.

It probably doesn’t matter to those who take it for symptoms

It does to me as I am looking for trustworthy information outside symptom related

Deficiency to me means you are missing something - where is the evidence that we are actually missing something? Where is the evidence that menopause shouldn't happen ?

It is a deficiency in hormones. Or a decline or a reduction. Whatever you want to call it. It’s the same meaning to the average Joe public.

Yes, we know average Joe Public is semi-literate with the vocabulary of Koko the Gorilla. But all the experts with “Dr” as their title should really know better and not be saying “deficiency” in place of “decline”.

I don't refer to Newson/ balance a great deal; the fact sheets are useful but it's the menopause matters forum and make menopause matters fb group and YouTube channel that I've found most helpful.

Diane Danzebrink set up a charity after her medical menopause disaster. I do feel she's now doing a little of what Newson does as is setting up her own consultancy. However her interviews with menopause consultants are really useful.

This one addresses many of the points raised in the thread - specifically long term health.

Consultant Nick Panay explains why the dementia / hrt query is really difficult to test within scientific boundaries, beyond observational studies. So he uses the terms "potentially" a lot, whereas they've been able to test cardio vascular and osteoporosis impacts.

Discusses windows of opportunity and also the woman's health initiative study that messed up public perception of hrt.

I have osteoarthritis in my hands. Nothing much can be done with it. During flares I struggle to type - impacts me cos my job involves lots of typing. I did my own research and found a couple of papers that suggested HRT might help. It wasn't conclusive but the data suggested possible improvements.

I decided to do my own trial. I have only been on it for few weeks but I do notice an improvement and today I noticed the bumps on the joints seem smaller. There is one finger that is stubborn and remains painful but I think less painful.

I also have arthritis in other parts that also seem less painful but there isn't anything you can see. The hands are useful as the arthritis is visible.

So, the evidence isn't there but I guess I had a working hypothesis. I will monitor for a while as arthritis can wax and wane so I will need to see consistent improvement.

I had virtually none of the typical symptoms of menopause and in lots of ways felt better - I have real clarity of thinking for example. And I do like the idea of not being too agreeable. So far I am still disagreeable so that's good.

I keep coming back to trust women to make their own judgement.

Hormone deficiency is an interesting way of looking at it but I agree not necessarily helpful for majority of people but maybe those of us with specific issues that seem to get worse with menopause could be described that way.

I'm glad it's helped you Jewel. It really helps a colleague and her hands.

This is a recent piece of research on estrogen and progesterone hrt:

Conclusions: Combined HRT was associated with a 9% lower risk of all-cause mortality and estrogen-only formulation was not associated with any significant changes. Tweetable abstract: Estrogen-only HRT is not associated with all-cause mortality and combined HRT reduces the risks.

https://www.researchgate.net/publication/356187331TheeeffectoffhormonereplacementttherapyonnthesurvivallofUKKwomenaaretrospectivecohorttstudy_1984-2017

I had swollen joints in my hands. Was really concerned as I use a computer all day. I couldn’t get my rings off. Couldn’t put my feet down flat in the morning either. Saw a menopause specialist who said HRT would resolve this. It did. Immediately. Five years later it still works.

@Feelingoktoday I really really hoped HRT would help wit this but despite trying various types I simply couldn't live with the side effects of the HRT. Rock and a hard place spring to mind.