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A GROUP OF medical experts writing in a new series of articles for The Lancet journal have called for a reappraisal of how societies view menopause and the treatments prescribed for it.
The experts argue that menopause should not be treated as a health problem to be solved by hormone replacement, saying that this approach deflects attention away from “the need for substantial societal shifts” in how menopause is viewed and treated around the world.
In the editorial that accompanies the series, The Lancet says that commercial companies and individuals have “over-medicalised” menopause by casting it as “a disease of oestrogen deficiency”.
The series also highlights how some groups of women, like those who experience early menopause or have it induced by cancer treatment, are often given suboptimal care.
The authors question “the assumption that menopause often causes mental health problems” while acknowledging there are some at-risk groups, such as those who experience severe hot flushes and night sweats, or those recovering from cancer.
An issue of concern identified by the authors is the prevalence of companies marketing therapies for people experiencing menopause.
“Unfortunately, commercial interests, such as organisations who are marketing menopause products to consumers including pharmaceutical companies and private providers, have strongly influenced media messaging about menopause and menopause hormone treatment (MHT),” they said.
The authors argued that through this messaging “the small but serious risks of MHT are often downplayed or ignored”.
They also argue that menopause should be viewed “as part of healthy ageing”, in order to reduce stigma around the life stage.
One co-author of the series, professor Martha Hickey from the University of Melbourne, said:
“The misconception of menopause as always being a medical issue which consistently heralds a decline in physical and mental health should be challenged across the whole of society.”
“Many women live rewarding lives during and after menopause, contributing to work, family life and the wider society. Changing the narrative to view menopause as part of healthy ageing may better empower women to navigate this life stage and reduce fear and trepidation amongst those who have yet to experience it.”
She said the Lancet series calls for “an individualised approach where women are empowered with accurate, consistent and impartial information to make informed decisions which are right for them over the menopause transition”.
Another of the series’ co-authors, Dr Lydia Brown, also of the University of Melbourne, said that while it is the case that some women have “extremely negative experiences” of menopause and benefit from hormone therapy, “that isn’t the whole picture”.
“The reality is much more complex and varied, with some women reporting neutral experiences and others highlighting good aspects, such as freedom from menstruation and menstrual pain,” she said.
She added that menopause is having “a cultural moment”, and this presented an opportunity for it to be recognised as “a natural part of healthy ageing for women which, with the right preparation and support, is not something to fear”.
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When all your hormones have left your body, leaving you with aching joints, unable to sleep, and with your brain fog destroying your career as well as horrendous sweats, crippling anxiety that you never had, hrt is the saviour that gives you your life back. No body just takes hrt in an unresponsible manner, that do so under their doctors guidance and advice. It’s not for all obviously but the suggestion that women should suffer is ridiculous because ‘it’s natural’.
@Lilly Lalogue: Your last sentence? Nobody said that!
@Sean O’Dhubhghaill: it’s in the last paragraph mate.
@Fiona Wyse: which says ‘with the right……. support’.
@Sean O’Dhubhghaill: what do you think in your medical opinion is the best support to replace depleted hormones? Do you think that you can do therapy to make your body think that you have extra hormones and then that will give you back your cardiac protection of oestrogen?cholesterol regulation protection? Hair loss protection? I’ve been losing my hair for the last year, I’ve been on Regaine for the last 6 months with no joy. Started HRT and now my hair loss has stopped because… oh my lost hormones have been replaced. The testosterone was becoming too dominant in my follicles in my hair which was causing hair loss but now that has been rectified. Please tell me how this issue can be fixed without medication I’m dying to know. And don’t insult me by saying get a wig. Just don’t
@Sean O’Dhubhghaill: Often people with cancer can’t take any hormonal treatment, not even herbal ones that would mimic the functions of estrogen. It’s tough enough with HRT, my heart goes out to people trying to manage without any support whatsoever.
@Fiona Wyse: If you are getting support that works for you, then that is the right support for you. But that does not mean that everybody else must get the same support. Coeliacs must avoid gluten. But that does not mean gluten is harmful and should be avoided by everybody. Every woman needs the right support for them. Not what their friend gets. Not what their neighbour gets. Not what trend-setting ‘influencers’ get, but what they, as individuals, need.
@Sean O’Dhubhghaill: You clearly have no idea on the vast types of HRT available. There is no one dosage fits all. It takes weeks and sometimes months to tweak as each woman has different needs. And there is no law that says a woman needs to get hrt, if they are not bothered about their future cardiac and bone health and not suffering symptoms they can ignore hrt. You are getting schooled, you have no clue what you are on about, back in your box little man stop making a show of yourself!
@Fiona Wyse: Your sentence says it all. “……… as each woman has different needs.” Exactly. Appropriate support. The right support for them.
@Sean O’Dhubhghaill: Where is hrt being made mandatory? It’s not. Just stop. Typical man drama you are worse than a woman.
@Fiona Wyse: I never said ANYTHING like that! Mandatory HRT??? Where did that appear from?
@Sean O’Dhubhghaill: I just pointed out the phrase “…… with the right support.”
@Sean O’Dhubhghaill: In fact, I started off commenting on the fact that many facets of health care around child birth have been ‘over – medicalised’.
@Sean O’Dhubhghaill: Women on HRT are not over-medicalised, they’re on it because they’re suffering! HRT brought me back from almost feeling suicidal because suddenly i couldn’t put my socks on due to pain, and i had been xrayed, done physio etc but it was the hrt gave me my life back. If you only knew the 100s of women that have gotten their lives back you’d not say it was over-medicated. It doesn’t work for all but nobody would say to a person don’t take cancer treatment or don’t take painkillers for a headache so why are women guilted for taking something that allows them to feel normal. And to avoid silly situations like people sayng that they’re having a hot flush! They’re not fun.
Can things just not be left alone? Decisions on a case by case basis? Women know their own bodies. They will ask if they need help.
The dredging of everyone else’s opinions is getting boring.
@lastfewchocices: ‘Women know their own bodies. They will ask if they need help.’
Nobody knows the full implications of menopause yet: it is an area that has been under-studied and under-researched (because it’s ‘a women’s thing’ and ‘natural’), while many women have gone through hell. How could ‘women [being] empowered with accurate, consistent and impartial information to make informed decisions which are right for them over the menopause transition” be a bad thing?
@lastfewchocices: “Women know their own bodies. They will ask if they need help.”
True but currently the “help” they’re being offered back is so often wrong. A huge percentage of women are incorrectly put on antidepressants when they present with menopausal symptoms. I know a woman was told by her GP that “perimenopause wasn’t a thing” and dismissed all her concerns about monthly mood swings she was having, suggesting she was bipolar. As @Brendan O’Brien: says above, having women empowered with correct information will help them in “asking for help”
@Brendan O’Brien: I agree. I am in chemical menopause and cannot take HRT due to the cancer meds but am trialing new alternative medications for which I am grateful to ease symptoms…..yet sometimes I feel like a guinea pig.
@Maria: I hope that you will have long-term relief and wellbeing.
The good news is it should only take the HSE another 40 years to ‘review’ this research and ‘take it into account’ before changing nothing!
Perimenopause is a depletion of hormones. This causes issues and a decline in the quality of a woman’s life. Women are living longer, why the hell wouldn’t you want to replace the hormones to make everything back to normal and to prevent cardiac issues and brittle bones etc. Would you want this for your wife?? Your sister, your daughter? Nobody wants to see the person they love suffer when there is a replacement therapy available to them. Men can buy viagra over the counter for their dysfunction.HRT is the female version!!! CBT therapy is not going to protect against the cholesterol regulation function of estrogen the last time I checked, you can’t think your total cholesterol scores down! Utter nonsense.
@Fiona Wyse: Thank you. That’s the first time I’ve heard anything about estrogen playing a role in cholesterol reduction.
Afraid to comment.
@Mike 100: Afraid to show the wife
@Mike 100: I’ll dip my toe in the water. Anything for men who are living with someone with menopause?. Just starting my car, getting ready for responses.
@Dave Barrett: collect your prescription in the offo…
@Jack Jack: If he loved his wife he would be as annoyed about this as much as she would be. Couples go through this together, it needs to be tackled together for a successful outcome. Exercise together, nutrition together, help with reminders about medication etc, why let somebody you love go through this on their own. It’s poxy but that support from your other half is vital.
@Fiona Wyse: “wife” replaced by “Durable partner”
@Dave Barrett: Yeah…… that’s a no from me lol!
@Fiona Wyse: Oh, but all women are there to support men. All the time. It’s a bit radical to suggest that we might need some minimal support ourselves!
@Dave Barrett: I hope your car goes fast
I went through the menopause at 39….the support I received was a sad face from my doctor!
Birth became over-medicalised in the 1970s, and in this country still is (look at the rate of cesarean sections!). It is time we stopped looking at these issues as ‘conditions which have to be treated’ but as ‘events which should be monitored’.
@Sean O’Dhubhghaill: and if your partner, wife, daughter died unnecessarily in childbirth because this ‘medicalisation’ wasn’t available, would you still take that stance?!
@Ashling Fenton: You obviously missed my ‘events which need to be monitored’ bit. The maternal mortality rate in Ireland hovers between 0.003% and 0.005%. It is INCREDIBLY uncommon. For the vast, vast majority of births there is no need for medical intervention. Monitor, yes. Intervene, no, except in those rare cases.
@Sean O’Dhubhghaill: Do you reckon the low maternal mortality rate has anything to do with advancements in medical procedures, or would you prefer that people just squat in a field?
@Jason Memail: you do realise that there’s a whole lot of options between squatting in a field and routine elective cesareans?
We have a ridiculously high rate of cesareans in Ireland, probably linked with how litigious we are as a population!
@Soundy Sound: Agreed, it seems to be a cultural thing. In other countries even pain relief during birth is not given to the extent it is here.
But the pre natal care is taken more seriously there as well.
Ageing first time mothers and unhealthy bodyweight prior to pregnancy appear to be another aspect of selective c sections.
On the menopausal issues – it’s part of nature without a hidden agenda and in all likelihood a much needed reminder that we’re “only human”.
Regardless medical advances we’re not Superwoman. We need to listen to our bodies and help them ‘do their thing’.
(the other half)
@Sean O’Dhubhghaill: Menopause isn’t an ‘event’. It’s a phase of a woman’s life, which we enter and remain in.
Can we have at least some choice how to deal with it?
I know some women are ok or pretend to be ok, but a lot of them don’t feel that way.
And I don’t get why first comments come from people who can’t and never will go through menopause nor labour:)
@Margaret E: I am one of these women who are ok. No hot flushes or brain fog. When I told my GP ( was seeing him for something else) that my periods had stopped, do I need hormone levels cheched or something, he just waved it off. A couple of years on, had a routine smear test and the (different) doctor said, casually, that I have rather bad vaginal atrophy. Didn’t even know what that is, and that there is a treatment. “Natural ageing” presumably means no sex, which becomes extremely uncomfortable. Menopause may be over-medicalised in Australia, but in Ireland it is just waved away.
@Zmeevo Libe: Maybe it’s partly because there’s a more matriarchal culture in Ireland. It’s a bit like being the eldest; you’re expected to help sort out everyone else’s difficulties, but not to need anything for yourself. It’s as if you lose face by asking for any accommodation. Meanwhile people are fuming or withdrawing from what they used to enjoy, and being patronised or told to live with whatever change brings isn’t helpful!
@Zmeevo Libe: Thanks for sharing Zmeevo :) sorry to hear about your artrophy :( this is what I am talking about, cause I don’t want to give up sex before of after the menopause! If I have choice. I don’t want to have any side effect of menopause ,if possible or I want them to be delayed as much I can.This is really important for myself but also for my family. We are left on our own most of the time during and after the menopause .I feel like no one cares about us after we can’t have babies anymore or can’t/want have sex because of the menopausal symptoms!
However the onset of menopause is addressed,the real elephant in the room is the ageist attitude towards women of a ‘certain age’ . The inference that lack of attractiveness equals inability or low aptitude is everywhere. Why else would so many middle aged women desperately be nipping ,tucking,botoxing,filling etc ? I. Whilst there are always exceptions,generally, older women are seen as grandparents and little else. It’s difficult to ‘grow old gracefully ‘ when passed over for promotion or ignored in job applications
That’s the real medical problem ; unecessary cosmetic surgery…not a clinically necessary hormone adjustment to offset horrendous symptoms.
From the quotes in this article, it seems like the piece in the Lancet is an opinion piece rather than a paper generated from peer reviewed research. The bottom line is a competent medical professional should be able to treat their patient as appropriate to that patient. Some doctors are reckless, lazy, overworked, etc, and those doctors may not be serving their patients correctly. Every few years, there’s some alert like this about over prescription of some medication or other. Anti depressants v therapy, addictive painkillers v pain management, etc. I went to my doctor with joint pain, thinking the osteoarthritis my podiatrist had told me I will (excessive joint damage in sports) develop was starting, but instead, I found out it was perimenopause.
@Morrigan Media: It’s not even to do with doctors being lazy or overworked, a huge number of them are clueless when it comes to menopause. I’m sure the majority of women learn about it from their peers, certainly not their doctors.
@Sean O’Dhubhghaill. Laurence Sterne, in The Life and Opinions of Tristram Shandy, Gentleman, lampooned the over medicalisation of childbirth. This was published in the 1760′s. Plus ca change.
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