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Menopause is being ‘over-medicalised’, say experts

The menopause is not a disease and is being “over-medicalised”, experts have said.

High-income countries commonly see menopause as a medical problem or hormone-deficiency disorder with long-term health risks “that are best managed by hormone replacement (therapy)”, they said.

Yet, around the world, “most women navigate menopause without the need for medical treatments”, the experts, including from the Royal Women’s Hospital in Melbourne, Australia, and King’s College London, said.

They argued there is a lack of data on whether health problems are caused by menopause or simply by ageing.

For example, although bone density is known to decline after menopause, “whether menopause at the average age increases other chronic conditions such as diabetes, dementia, or cardiovascular disease is uncertain”, they said.

In a first paper in The Lancet Series on the menopause, the experts said: “Although management of symptoms is important, a medicalised view of menopause can be disempowering for women, leading to over-treatment and overlooking potential positive effects, such as better mental health with age and freedom from menstruation, menstrual disorders, and contraception.”

The team said that how women feel when going through the menopause can be difficult to differentiate from other things happening in their lives, such as caring for children, working, and looking after elderly parents.

Issues that are sometimes put down to the menopause – such as changes in mood, brain function and sexual problems – could actually be caused or made worse by these stressful life events, they said.

Instead, they argued for a “new approach” to the menopause based on “health empowerment”, where women are given the knowledge, “confidence and self-determination to self-manage their health” and make informed decisions.

They suggest there are other methods for dealing with symptoms such as hot flushes, including cognitive behaviour therapy (CBT) and hypnosis, arguing that CBT has been shown to have a small to moderate effect on cutting hot flushes, night sweats, sleep disturbance, depression, anxiety and fatigue.

Medics should also look at women’s lifestyles, such as sleep, alcohol intake and smoking, which can make symptoms worse.

While hormone replacement therapy (HRT) has been shown to improve sleep, memory, and concentration in women taking it for hot flushes, it is “unlikely to have any effect in women without” flushes, they said.

And while it cuts the risk of bone fractures, evidence shows these benefits can dwindle five years after HRT is stopped.

If women do want HRT, the experts said medics should provide “realistic information about the likely effects of treatment, the potential for residual symptoms, and the possibility that symptoms could recur when treatment stops”.

A second paper in The Lancet Series found no evidence of an increased risk of mental health disorders for women going through the menopause.

“On the basis of scarce data, we found no compelling evidence that risk of anxiety, bipolar disorder, or psychosis is universally elevated over the menopause transition,” the team said.

Series co-author Professor Martha Hickey, from the University of Melbourne and Royal Women’s Hospital, 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 told a briefing the team is arguing that “menopause is not a disease”.

She said: “In a society that has very strong feelings about ageing and women, this is a disease which is thought to herald decline and decay amongst them.”

Dr Lydia Brown, from the University of Melbourne, said: “Whilst it’s certainly the case that some women have extremely negative experiences of menopause and benefit from hormone therapies, 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.

“Menopause is having a cultural moment, and this is 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.”

Dr Louise Newson, a GP and menopause specialist running Newson Health, said: “Menopause is more than a collection of symptoms; it is a cardiometabolic and inflammatory condition which leads to an increased risk of numerous diseases.

“Menopause has been ‘medicalised’ for years – including with antidepressants, antipsychotics, painkillers, sleeping tablets, anticholinergics to treat bladder symptoms, and heart medications to lower cholesterol, reduce blood pressure and control palpations.

“The first-line treatment for menopausal symptoms is body-identical HRT…

“Studies have shown that when women are given the right dose and type of hormones, their symptoms improve, and they have a lower future risk of numerous long-term inflammatory diseases associated with menopause including diabetes, cardiovascular disease, osteoporosis, dementia, and depression as well as early death.”

She added: “Talking about menopause as being a ‘natural transition’ or part of ‘healthy ageing’ ignores the very real suffering of many women with menopausal symptoms.”

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