Final week’s controversial BBC Panorama episode, The Menopause Business Uncovered, got here as a shock to many.
The primary half of the 30-minute movie raised considerations over costly menopause dietary supplements being bought within the UK, regardless of having no clear profit.
Nevertheless, the second a part of the documentary was extra worrying. It alleged that some non-public menopause medical doctors are placing the well being of ladies at-risk by prescribing extraordinarily excessive doses of HRT. The present targeted on one specialist and her clinic particularly – the movie star menopause guru Dr Louise Newson.
HRT drugs can play an necessary function in tackling signs of the menopause
In response to Panorama, her non-public observe – The Newson Clinic – is prescribing one in 5 of its sufferers with doses of HRT effectively above the beneficial limits.
Dr Newson and her colleagues declare these excessive doses are essential to manage the debilitating signs triggered by hormonal adjustments, together with scorching flushes, disrupted sleep, and psychological well being issues. However Panorama highlighted 12 circumstances of ladies who claimed that they had been harmed by the treatment.
As a GP with an curiosity in girls’s well being, I’m upset by the revelations however not stunned.
I’ll say no extra about that particular case, and the hospital watchdog the Care High quality Fee is now investigating. However I’ve lengthy been involved in regards to the over-medicalisation of the menopause – and a small however vocal group of campaigners who declare it’s not merely a standard stage in a girl’s life, however a illness or ‘deficiency’ that wants treating.
It’s a difficulty I contact on in my e-book, The Science Of Menopause, printed this week. As a result of whereas I perceive the speculation, I couldn’t disagree with it extra.
It cements the concept that we’re ‘damaged’ and missing, when the menopause is a standard, anticipated a part of getting older.
That’s to not say that I’m towards HRT – I’m not.
Ladies’s lives could be destroyed by menopause signs. They’ll smash careers, set off relationship breakdowns and divorce, and have a catastrophic influence on psychological well being. One in ten girls contemplate suicide in consequence.
Final week, new information confirmed 60,000 girls are off work long-term as a consequence of menopause signs. For a lot of of those sufferers, HRT could be transformative.
Menopause was one thing that was by no means talked about. I’m grateful that, because of celebrities and campaigners – together with Dr Newson – that has modified.
It means those that endure usually tend to get the medical assist that they want.
However, like many colleagues, I feel the pendulum has swung too far. The reality is that not each girl wants HRT.
The concept of the menopause being a illness isn’t new – it dates again to the Sixties.
A bestselling e-book printed in 1966, known as Female Ceaselessly, by Robert Wilson, outlined the idea. The British-born, US-based gynaecologist claimed the menopause was a hormone deficiency, which was ‘curable and completely preventable… simply take oestrogen’.
HRT, Wilson argued, was not merely useful however essential as a way to free girls from the ‘curse’ of oestrogen loss. He believed that it needs to be taken for all times, not simply till the signs subsided.
Dr Louise Newson’s clinic is prescribing one in 5 of its sufferers with doses of HRT effectively above the beneficial limits
‘Many physicians,’ Wilson wrote, ‘merely refuse to recognise menopause for what it’s – a severe, painful and sometimes crippling illness.’
For anybody even barely persuaded by this, he additionally wrote that with HRT, a girl’s ‘breasts and genital organs is not going to shrivel. She will probably be rather more nice to
reside with and won’t turn out to be boring and unattractive.’
Clearly, that is misogynistic claptrap. It performs to the concept that girls are primarily valued for his or her seems to be, sexual availability and capacity to bear youngsters.
However, astonishingly, right this moment’s social media period has given this dreadful idea new life.
This time it’s been rebranded as girls taking management of their midlife well being in an empowering approach. A few of these campaigners and celebrities promote dodgy dietary supplements and fad diets which can be supposed to assist menopausal girls ‘flip again the clock’. Others advocate taking testosterone – the ‘male’ intercourse hormone that ladies even have in smaller quantities – to spice up libidos and enhance temper, focus and sleep.
The British Menopause Society recommends testosterone solely to sort out low libido – and solely in circumstances the place different remedy choices have been exhausted.
It has made HRT nearly fashionable – the most recent anti-ageing product.
Like most GPs, I repeatedly get requests for HRT from girls of their 40s and 50s who don’t have any menopausal signs.
Midlife could be messy for ladies, whether or not it’s menopause signs, which could be crippling, or simply the stress of juggling busy careers, teenage youngsters, relationships and ailing dad and mom – all on high of the traditional means of ageing.
Some challenges are hormonal, and if they’re then HRT will assist.
However whereas it could repair a few of these signs associated to hormone ranges, it received’t repair every thing. And it’s important girls don’t have unrealistic expectations about what the remedy can do.
When you’re on the utmost licensed dose of HRT, and also you’re nonetheless having signs, the answer could also be to take a look at what else could be inflicting them and contemplating including different remedy – comparable to antidepressants or speaking remedy – moderately than growing the dose additional.
For me, empowerment isn’t about feeling it’s important to be doing one thing, however about having a selection over what you do.
Menopause isn’t one-size-fits-all. Like several life stage, each girl will expertise it in a different way.
For some, easy life-style adjustments – a more healthy eating regimen and being extra lively – actually does assist. For the one in 4 who expertise extreme and debilitating signs, HRT performs an necessary function. Trendy varieties, out there as gels, sprays and patches, moderately than older-style drugs, are safer than ever.
We’ve good proof that, for ladies who want it and might take HRT, the large advantages outweigh the small threat of breast most cancers or blood clots.
However there’s not sufficient proof, except you went via early or surgical menopause, that HRT will defend you towards coronary heart illness or dementia – no matter what you would possibly learn on social media.
Claims comparable to these simply provoke concern amongst girls who can’t take HRT as a result of they’ve a historical past of breast most cancers or different severe well being issues.
Reasonably than being informed they’re damaged, or have a illness that wants treating, girls must know they’ve decisions.
I’m typically requested if I’m professional or towards HRT. It feels an odd query. Crucially, I’m professional what helps my sufferers – and the answer isn’t all the time HRT.
The Science Of Menopause, by Dr Philippa Kaye, is printed on Thursday (DK, £16.99).
