DR. MARGARET MCCARTNEY: Menopause is not just a ‘problem’ that can only be solved with HRT

HRT – hormone replacement therapy – is hardly out of the news.

After falling out of favor in the early 2000s, its rise has been unstoppable in recent years: in 2022-2023 the NHS will have handed out 47 percent more HRT prescriptions than the year before.

It’s hardly a surprise, given the amount of publicity, celebrity endorsements on TV and social media, and the claims being made about it. There is no doubt that HRT is a very effective treatment for the classic symptoms of menopause such as hot flashes and night sweats. However, promises on social media go much further.

They provide great skin, ‘vitality’, ‘new energy’, relief from anxiety, ‘brain fog’, muscle pain and fatigue. Instagram is full of middle-aged women who look fantastic and endorse HRT. Closer to home, presenter Davina McCall has said that taking HRT will ‘give me a little more protection (against Alzheimer’s) than if I didn’t’.

The subliminal message is that menopause is a medical problem and needs to be treated.

Now a series of articles in The Lancet by a group of leading women’s health researchers are calling for more nuance about menopause and the ways we treat it.

Even the name “hormone replacement therapy” implies that women are deficient; the researchers call it ‘menopausal hormonal therapy’.

Significantly, they say that “commercial companies and individuals with vested interests have over-medicalized menopause” and that “framing this natural menopause period as a disease of estrogen deficiency, which can only be alleviated by replacing the missing hormones, is a negative attitude. to menopause and worsens the stigma’.

I have to agree. I remember years ago, women were rightly annoyed when their doctors told them that every symptom they had was due to “their hormones,” when in reality they had other conditions that weren’t being investigated. It seems we have come full circle.

Some women clearly have a difficult menopause, with severe and multiple symptoms, and experience great benefit from HRT.

Presenter Davina McCall has said that taking HRT ‘will give me a little more protection (against Alzheimer’s) than if I didn’t’

But there are also women who are disappointed by it and feel that it does not live up to the claims made on social media.

There are also many other women who do not need any treatment, or who cannot take HRT (for example women with breast cancer), who wonder whether they are condemning themselves to dementia or a heart attack by not taking HRT. on the plasters.

The question is how we can ensure that women receive high-quality information that is not biased or overpromises what HRT can deliver.

Last year, the All-Party Parliamentary Group (APPG) published a manifesto on menopause, following its own research. It included a call to financially incentivize GPs to diagnose menopause and license a female-specific testosterone (currently, women prescribed testosterone are given this on an off-label basis as there is no female-specific product registered in Britain).

But financial incentives for diagnosis can have unintended consequences, such as “diagnostic overshadowing,” which does not fairly take into account other circumstances.

And imagine thinking that your doctor is only considering diagnosing menopause to make money off your diagnosis.

There are women who are disappointed by HRT and feel it doesn’t live up to some claims on social media (Stock Image)

As for testosterone, the APPG said there is ‘some evidence’ that it will treat fatigue and ‘brain fog’ – but an independent review in 2019 found no evidence of this. It came as no surprise to me that the APPG’s research and manifesto were funded by pharmaceutical companies – including Astellas, Bayer and Theramex, which make or develop medicines for use in menopause – with both investigated by Dentons Global Advisors ( which has numerous pharmaceutical products). customers).

None of this means that HRT doesn’t work, but there is a risk that women are being oversold to a treatment that carries the risk of side effects and doesn’t do what it promises.

Menopause can ultimately be presented as a simple problem to be solved – a menopausal woman is deficient in hormones and therefore needs to replace them – rather than as a complex, nuanced picture (some women will benefit from hormones, others not; some symptoms may be caused by menopause, others not; some women will have few symptoms, others will not).

Consider the social media backlash over menopause guidelines issued last year, when the National Institute for Health and Care Excellence (NICE) suggested that cognitive behavioral therapy (CBT) may help some women manage symptoms. This led to complaints that the symptoms were dismissed as ‘all in the mind’.

Yet there is good evidence that many women find cognitive behavioral therapy useful: it is already used for other conditions, including chronic pain, and the point is to give people useful ways to cope with symptoms – not to say that their very real symptoms being ‘merely’ psychological.

There should be room for choice in evidence-based approaches, but the current HRT-menopause axis does not allow this.

Meanwhile, it’s clear that menopause is driving a growing industry to sell products purportedly designed for women in their 50s. Instagram is full of supplements, skin and hair care, all intended to provide menopausal benefits.

I’ve spoken to several young women who watch the reporting with a silent dread, dreading the arrival of menopause.

Dr. McCartney believes there should be room for choice in evidence-based approaches, but the current HRT-menopause axis does not allow this.

Yes, some women have a terrible time. But we owe it to women of all ages to make it clear that for some it is liberating, free from periods and the need for contraception – and for others the symptoms are mild and it is more of a non-event.

Women are still losing; we may be more aware of menopause, but I don’t think this has led to better information.

So how can we make better choices? Seek out independent information – from organizations that have no vested interests, are not funded by the pharmaceutical industry and don’t want to make money by selling you stuff.

I also look for information that can honestly explain the pros and cons; miracle cures do not exist.

Finding your way through hype and sales pitches isn’t for the faint of heart, but if you ever needed to find unbiased medical advice, it’s here.

Dr. McCartney is a GP in Glasgow and a senior lecturer at the University of St Andrews.