"What we’re seeing is an incredible emergence of a for-profit industry associated with menopause"

[GoodOldEmmaNess]

Not sure why we need researchers to tell us this, since it should be flaming obvious to anyone how the menopause has been pushed and pushed to us all over the last few years as some sort of glitch in femaleness that makes us ALL go faulty in middle age.

It is so flaming regressive. Some women are ill as a result of menopause, and need proper medical help and support, but the menopause itself is not an illness.

Until just a few years ago, we fought against the idea that 'women of a certain age' were defined by their transition to a post-reproductive phase in their life. That was part of feminism. Now we are being sold a false narrative that seems to regard pathologising the menopause as a form of empowerment.

https://www.theguardian.com/australia-news/2024/mar/05/companies-portray-menopause-as-medical-problem-and-push-women-towards-ineffective-treatments-papers-find

That's appalling. I'm so sorry.

Two wrongs don't make a right

Women should be able to access HRT pretty much on request

But we shouldn't be giving the impression that menopause is automatically a disaster for women because it's untrue, and unhelpful

And we shouldn't wholeheartedly support an industry whose priority isn't helping women but is helping their bottom line because the two goals may ( often do ) conflict

As the saying goes, absence of evidence is not evidence of absence. I agree with you that many patients find that HRT relieves lots of menopause symptoms beyond just sweats.

As several PPs have said, the menopause (like many aspects of women's health) is very under-researched, and what research does exist is by Pharma, so focuses on selling women stuff (HRT), not on alternatives. We can't expect Pharma companies altruistically to research alternatives to their products; we need independently funded research through universities and other research bodies.

The paucity of research is one reason why patients get such different views from different doctors. There are a huge number of uncertainties about HRT, with the research having totally contradictory findings in some cases, especially its effect on cardiovascular risk and dementia risk. I genuinely do not know, when prescribing HRT, how likely it is to harm the patient. That is a very uncomfortable situation for a prescriber - and for the patient.

I often offer HRT, only to have a woman decline it when we have a discussion about the possible risks. And I'm not trying to put anyone off - I use HRT myself, despite some family risk factors. and I have prescribed it for women who are high-risk, as long as I am satisfied that they understand those risks. But the situation is a lot more nuanced that the Davina take that "All woman should be on HRT and it's only evil GPs who are standing in their way". All of us: doctors and patients are currently in the dark about many important issues on the safety of HRT and effective alternatives.

It does annoy me that the discussion around HRT focusses on its risks and not on the risks of antidepressants or indeed of not taking it at all - it's not a panacea but it can be life-changing.

It's also frustrating that, like so many conditions predominantly affecting women it receives less funding.

But it also annoys me when I see people claiming HRT fixes everything when there are risks and benefits to be weighed up.

And I am increasingly enraged by the proliferation of menopause branded haircare, skincare and supplements galore sold in a huge wave of meno-washing when the evidence for the benefits of these is dubious at best.

And I would like workplace discussions around menopause to reflect that while women's performance on memory tasks undoubtedly declines in menopause, it declines to the level typically seen in men.

In sum, yet another example where women deserve better.

It's a fair point about the need to discuss the risks of all options, and I agree that the risks of antidepressants - especially loss of libido - are often played down.

OTOH, HRT does have some potentially life-threatening risks, which is not generally true of SSRIs (some exceptions but they are very rare). HRT definitely increases the risk of breast cancer and, for oral HRT, blood clots.

This is another of the reasons why many doctors find it hard to advise women: you are balancing a risk of horrible symptoms now - and I agree completely that the menopause can wreck quality of life - with an increased risk of a potentially fatal disease in the future. That is a hard decision to advise on for any medical treatment, but it is much harder when we have so many uncertainties about the scale of the risk.

We urgently need research, particularly on whether the current practice of giving everyone with a womb (not gender bollocks - I mean women who have not had a hysterectomy) both oestrogen and progesterone as HRT. We know that giving oestrogen only increases the risk of endometrial cancer, but I have a suspicion that, over all, this risk may be lower than the increased risk of breast cancer with combined oestrogen and progesterone (NB this is only a suspicion at this stage - no one should stop taking progesterone, and I take it myself). We also don't know whether the risks of combined oestrogen and progesterone HRT are the same if you have the progesterone through a Mirena coil as if you take it by mouth.

Yes I agree. GPs need to be properly informed (I think I understand more about the menopause than some of them appear to, just from reading the newspapers and MN!) and they need to stop saying HRT causes breast cancer. Modern bio-identical HRT is very unlikely to. If someone wants it they should be able to have it.

Equally GPs should be properly informed about the alternatives, and how to help women who can't or don't want to take HRT.

And all the nonsense like menopause moisturisers needs to stop.

But employers do need to make allowances for women who need those allowances and we need to stop the narrative that they will use it as an excuse not to employ women over 50 because they don't want to employ women of any age and policies systematically affect women badly such as forcing people back to the office when they could easily work from home.

As for erectile dysfunction, it doesn't affect a man's ability to work, doesn't give him brain fog and doesn't make him bleed heavily. Completely different issue. Also doesn't affect all men.

OTOH, HRT does have some potentially life-threatening risks, which is not generally true of SSRIs (some exceptions but they are very rare). HRT definitely increases the risk of breast cancer and, for oral HRT, blood clots

I am not sure oral HRT is still given? It was made of horses' urine in the 1980s! We've come a long way since that!

It is still given orally, though, AFAIK, without the involvement of quadrupeds these days.

As I said before, my mother is a doctor (US) and she feels that GPs (herself included) really don't understand anti-depressants well enough to be prescribing them and feels strongly that only psychiatrists should prescribe them.

Ha, good luck with that. The US has 11 psychiatrists per 100,000 population. The UK has 2.

Interesting language about women being 'fobbed off' with antidepressants too. Are we saying that only physical ailments are real, and that treating the mood disorders of menopause is somehow less valid?

Antidepressants are not the right treatment for all women with menopause mood disorders, but the choice is by no means clear-cut, because of the complex inter-relationship between physical and mood symptoms. Some women find their lives transformed by HRT. Some women find their lives transformed by anti-depressants. Some women should not be on either. It is really unhelpful, and contrary to the interests of women, to characterise one treatment as being superior to the other, when the evidence does not support this.

@UnaOfStormhold “And I would like workplace discussions around menopause to reflect that while women's performance on memory tasks undoubtedly declines in menopause, it declines to the level typically seen in men.”

this needs to be all over the information at work! Do you have a link to any research please? Thank you.

I think that is all fair, and illustrates a lot of themes on this thread. We should avoid dismissing the mood/emotional aspects of the menopause, but also avoid attributing everything that women experience to low mood. It's really hard to get right, even when you are trying really hard to do so!

The honest answer is that you cannot always tell at the outset what the best treatment for an individual is, and you need to be honest with the patient about that, pay attention to her preferences, and be open to changing treatments, if they aren't helping.

What worries me about the current push to promote HRT and criticise GPs who offer anti-depressants, is that HRT is not what all women want, or what suits all women best. I agree with your mother that, in general, antidepressants are over- prescribed. However, one group of patients who often do really well on them, even if prescribed for quite a short period, are menopausal women. We don't want to push women who could really benefit from ADs towards HRT, if that may not suit them as well.

@EmmaEmerald I originally found that comment on Jen Gunter's paid for site Vagenda (worth the small cost in my view). This summary is in the public domain https://www.health.harvard.edu/blog/menopause-and-memory-know-the-facts-202111032630. I do like the way they frame it - this language should be more common in workplace guidance - "On average, women perform better than men on measures of verbal memory, beginning as early as post-puberty. However, women's advantage for verbal memory performance is reduced with menopause."

@MissLucyEyelesbarrow It's the downplaying of the risks of osteoporosis that particularly bothers me - hip fracture is sadly common (I've seen stats suggesting more common than breast, endometrial and ovarian cancer put together) and has a lower survival rate, and HRT is shown to reduce the risk of fractures.

The most annoying part about the whole issue is that I have found that I've not been listened to, or when I have (swollen achy joints, hands and feet) not my GP nor the expensive (to the NHS) consultant rhuematologist that I was referred to, had any idea that this was a menopause sympton, which could have saved a battery of expensive tests and time for patients who were in need of rheumatology input.

I started a private HRT prescription halfway through the referral process, and mentioned that my symptoms had improved considerably as told it couldn't possibly be because of the HRT and that I just had minor osteroarthritus due to wear and tear, normal for someone of my age.

What I find really insulting is that women's experience of their own bodies and health is routinely downplayed, minimised and discounted. This is male medical bias, it's normal and it needs to be called out. We're not hysterical - we know our own bodies.

My issue with prescribing menopausal women ADs when HRT is likely to help, is that the fact you've had them is on your records. From that time on, every time you have something (physically) wrong, a GP (assuming you can see one) will say you're anxious or depressed and fob you off with more medication for those, even though you know it has a physical cause.

We know women get fobbed off already, and you don't want GPs to have any more ammunition. People of both sexes get fobbed off when they and consultants can't find a cause for things and say it must all be in the mind because they can't be bothered to look harder.

Also if you are feeling rubbish during menopause, you are likely to feel low. That doesn't mean you need ADs, it means you need the physical symptoms sorting out.

I probably expressed myself badly. I meant medication that is not needed and does not help with either symptoms or outcomes but can be passed-off as a remedy. HRT etc and herbal remedies are fine, either prescribed (HRT) or researched and found in a health food shop.

Motherwort or Ashwaganda, just bear in mind that herbs are powerful and some have contra indications, best to consult a qualified herbalist but they can really help. Ground linseeds in smoothies, porage etc, can help with hot flushes.

Evening primrose oil is recommended for menopausal symptoms. Not tried it so not quite sure what it does. But worth a try?

I went to gp with sudden crashing headaches that had me lying in a darkened room for 4 hours. Rarely had headaches previously.
Expecting a brain scan, got HRT. Headaches gone, but now I've got heavy bleeding and fibroids. Tough choice really.

I was on hrt after increasing issues with perimenopause symptoms though I'm also hypothyroid and I think they affected each other. It helped with some things but bleeding was worse and that was half the issue. Testosterone was great but was only on for a couple of months.

Was diagnosed with breast cancer a year ago (it had probably been growing for 10 years) so had to come off it and on to tamoxifen (just lumpectomy and radio needed)

Have to say I really do see the aggressive marketing of menopausal products and supplements. It's exploded in the last 2 years. Facebook bombards me with stuff I can't take and I know won't help.

And what's never mentioned is boring old diet and exercise. Because it's almost free. It's taken a year and I did take 6 months off to deal with coming off hrt, side effects of tamoxifen, op recovery, radiotherapy and fluctuating thyroid levels (which I've only recently got on top of) but i genuinely feel better than when on hrt.

I feel lucky that I was diagnosed with the cancer (not least as it was dealt with asap) because I could take the time to really work on my lifestyle. Some nights I didn't sleep at all thanks to half hourly sweats when starting the tamoxifen and I could t have worked. I have primary aged children and they needed me.

It's been specifically resistance training that I feel has helped the most, and eating for building strength. More recently SIT training, via 'next level roar' by Stacy sims. More protein, but mostly plant based. I'd already read the xx brain by Lisa mosconi and I do think that's really helpful if on or not on hrt. (She seems to be getting on the hrt bandwagon though.)

The whole gut biome thing has helped hugely. I had terrible gut issues. Hrt helped a lot. (Maybe tamoxifen is helpful, I don't know.)

Stacy sims worked on the women's health initiative as a research scientist.

I'm glad you're feeling better, ikea. Sounds like you've done amazingly well.

I didn't say women should not have help for e.g. menstrual cramps. I said I was worried about the commodification of health care and the use of gimmicky gadgets to control medical problems that have actual medical solutions.

Thanks @ArabellaScott

Mostly - hot sweats back this week and social anxiety is a bit high; but I went out partying and drank a few Proseccos at the weekend. And had very little sleep due to that and a child with nightmares. Things like that do seem to make things worse. But the exercise definitely makes it all more manageable.

It's the thinking skills I'm most delighted with. The brain fog before was crippling. (And it's been awful recently with low thyroid levels) I was absolutely terrified of not being on hrt and starting tamoxifen. Hrt had helped a bit. But it's so much better now even with tamoxifen, which does cause brain fog. I forget names of things and do have the odd day where I'm wiped, (which is as likely to be thyroid related) but can handle concepts and concentration so much better. My joints are better too.

When you start listening to the 'cancer and menopause influencers' (dr Liz o riordan, Dr Annice Muckerjee who is an endocrinologist who also had cancer) you start to see a bigger picture which takes in a wider range of things. Even Davina admitted in an instagram live with Danni Brinnington who runs Menopause and Cancer podcast and group that she doesn't drink alcohol, exercises loads, especially resistance training, and clearly has done Zoe according to the ads for that.

Re things like dementia and cognition, certain types of exercise have more evidence than hrt. Liz is especially keen to point this out and I think Newson blocked her on Twitter.

I also don't understand how dementia / Alzheimer's risks are actually lower for women who've had AIs and tamoxifen. As they block oestrogen.

Hrt does have its place, definitely. I don't want to say it doesn't. And we actually don't know the risks with hrt after breast cancer as they've only researched synthetic progesterone, (which is a risk, they think oestrogen on its own isn't) not utrogetstan. But actually, for those who can't, there is a huge amount out there too.

Vaginal oestrogen is very welcome though and I can take that!

@Ikeameatballlunch

I agree with all of that. The problem is with saying diet and exercise to someone who is already doing that and still suffering.

Re thyroid issues - have you tried liothyronine or one of the NDTs? Mine never really stabilised until I added active T3.

I do get that. And theres no way I could have done that when I first was given hrt. It's not easy. Women also it seems need entirely different exercise approaches.

Re thyroid; levels were affected by coming of hrt (testosterone) and then the operation and then starting tamoxifen which is something that directly interferes with it like oral oestrogen does. They (rightly) wouldn't test till things had stabilised which took a few months.

I think that's extremely well balanced now after this last raise, better than in years - but there again I've always known that's better when I'm doing certain types of exercise, which I wasn't doing a couple of years ago. But that is me and I know every one is different, especially with thyroid things .