Women must have HRT or they will kill themselves, campaigners claim… but where’s the evidence?

Is menopause so horrific that it drives some women to commit suicide? It’s an alarming claim, often presented as fact — at least, it has been for the past few years.

Most recently, it was created by high-profile menopause guru Dr. Louise Newson – a general practitioner and founder of the private Newson Health clinic chain, which sees around 4,000 patients a month, all seeking treatment for menopausal symptoms.

A Mail on Sunday study published earlier this month revealed concerns about her clinic, which is prescribing doses of HRT above permitted limits to one in five of its patients.

Experts warned that these high doses should only be used in “exceptional” circumstances, accusing her of endangering patients, as large amounts of some hormone drugs can increase the risk of uterine cancer.

Dr. Newson, on the other hand, emphasized that her approach helps vulnerable women who struggle with suicidal thoughts.

A Mail on Sunday investigation revealed concerns about Dr. Louise Newson, who prescribes doses of HRT above the permitted limits to one in five of his patients (file photo of woman taking HRT pills)

She added, “The doses allowed are simply the doses the pharmaceutical companies have done their trials with.”

Following our report, Dr. Newson – who is supported by celebrities such as TV presenter Mariella Frostrup – spoke to another newspaper about her position.

The play told the story of a woman in her mid-40s suffering from a series of mental health problems that got worse. Antidepressants ‘made no difference’, but high-dose HRT helped. Dr. Newson said that “many women” who visit her clinic have “very negative intrusive thoughts that mean they feel like they shouldn’t be here.”

She added that there was ‘no evidence that antidepressants help to improve the psychological symptoms of menopause’ and that ‘HRT saves lives’.

So, is she right? First, it’s important to look at the bigger picture: mental health problems are widespread. One in six adults suffers from depression, and ten percent seriously. It is about twice as common in women as in men. And some will be in menopause.

But does that mean menopause is the cause or the trigger? That’s kind of hard to answer – not that you’d know from reading other recent headlines. “Women left suicidal amid shortage of HRT products as menopause is ruining their lives,” read a post last April about the much-publicized HRT shortages. Another simply said, “HST life-or-death crisis.”

Most of these articles quoted campaigner and Labor MP Carolyn Harris as saying women in her Swansea East constituency were ‘literally suicidal’ because they couldn’t get HRT.

Meanwhile, Katie Taylor of the Latte Lounge, a menopause support group that charges £99 for an annual membership, said: ‘It’s no coincidence that the highest suicide rate among women is in the 45 to 55 age group. [when most go through the menopause].’ But is it? The ONS, which compiles causes of death figures, reported 5,583 suicides in 2021 – the most recent year on record. Three-quarters (4,129) were male, and the majority of these deaths occur in middle age (45 to 49 for females and 50 to 54 for males).

And it’s clear that men don’t go through menopause.

Mail on Sunday Health Editor Barney Calman

In women, the greatest increase in suicides is among women 24 and under, while suicide rates for women 45 and over have declined significantly since 1981. – a ‘fact’ that appeared to have been put out by a menopausal campaign group. But this is not correct.

A key factor in what causes people to commit suicide, according to the ONS, is socioeconomic status — suicide rates are twice as high in the most disadvantaged areas, compared to the least disadvantaged. And this gap becomes most pronounced in middle age.

Financial problems and debts, unemployment, broken relationships and ‘the demands of midlife’ – caring for children and elderly parents – all play a role.

As Samaritans points out, “Usually there isn’t a single event or factor that leads someone to commit suicide.” Could menopause symptoms be such a strain that sends some women falling over the edge? It is very possible. But a single drug treatment, or lack thereof, is unlikely to make a difference in such nuanced cases.

In her media guidelines for responsible reporting on suicide, Samaritans advises against speculating on a trigger or cause, as “suicide is extremely complex.” Given this, the “women must have HRT or they’ll kill themselves” rhetoric seems like a gross oversimplification.

There is some evidence that, on average, there are 10 percent more reports of depressive symptoms or low mood during perimenopause — the transitional phase prior to menopause when hormones begin to fluctuate.

‘How much hormones play a role is not easy to pinpoint,’ says Professor Myra Hunter of Kings College London, a psychologist with more than three decades of research into women’s health to her credit. “But symptoms such as low mood, trouble sleeping, stress and hot flashes can often interact in a vicious cycle and have a serious impact on quality of life.”

This, Professor Hunter explains, is why NICE guidelines say that HRT, which is highly effective in reducing all of these symptoms, should be considered for low mood during menopause, along with cognitive behavioral therapy.

Doctors are also advised against routinely offering antidepressants to women with menopausal symptoms unless they have been diagnosed with depression. “For depression, the type that can cause suicidal thoughts, antidepressants and cognitive behavioral therapy are proven treatments. And HRT can be used in combination with this if menopausal symptoms are a contributing factor.’

Labor MP Carolyn Harris (right with Lisa Snowden, left and Penny Lancaster in parliament), said women in her Swansea East constituency were ‘literally suicidal’ because they couldn’t get HRT

In the 1980s, gynecologist and HRT pioneer John Studd often treated women with mental health problems during menopause with very high doses of HRT. His research also revealed a phenomenon called tachyphylaxis, in which some overtreated patients required increasingly higher doses to control their symptoms.

And some developed serious psychological problems as a result. So it is clear that more HRT is not always better for mental health. But more to the point, Prof. Hunter, like many others I’ve spoken to over the years, is concerned that a generation of women is taking in the terrifying messages that menopause is going to be hell.

Research suggests that these concerns can make symptoms worse. In reality, most women do not have serious problems. But if they do, there’s a range of evidence-based interventions that can help – not always HRT.

As Prof. Hunter says, “There are many factors that influence mental health in middle age. Hopefully we’ll be able to get rid of all women’s problems due to our hormones now.’