Doctors warn against over-medicalising menopause after UK criticism
Doctors have hit back at critics saying they are failing menopausal women, and said that treating menopause as a hormone deficiency that requires medical treatment could fuel negative expectations and make matters worse.
Writing in the British Medical Journal they said there was an urgent need for a more realistic and balanced narrative which actively challenges the idea that menopause is synonymous with an inevitable decline in women’s health and wellbeing, and called for continued efforts to improve awareness about the symptoms and how to deal with them.
“Menopause is a natural event for half of humankind. While media attention in the UK may give the impression that growing numbers of women are struggling to cope with menopausal symptoms and are seeking hormonal treatment, there is no universal experience and most women prefer not to take medication unless their symptoms are severe,” wrote Martha Hickey, a professor of obstetrics and gynaecology at the University of Melbourne, Australia, and colleagues.
They added that over-medicalisation of the menopause risked collapsing this wide range of experiences into a narrowly defined disease requiring treatment.
“It tends to emphasise the negative aspects of menopause and, while effective treatments are important for those with troublesome symptoms, medicalisation may increase women’s anxiety and apprehension about this natural life stage.”
Women’s experiences of menopause were strongly influenced by personal, family and social factors, they said. For instance, a recent review found that negative attitudes and expectations before menopause predicted the likelihood of women experiencing distressing symptoms.
A separate study of UK women who were experiencing hot flashes found that those with negative beliefs about menopause were more likely to rate these symptoms as “troublesome” and report embarrassment and shame.
“Changing the narrative by normalising menopause and emphasising positive or neutral aspects such as freedom from menstruation, pregnancy and contraception, together with information about managing troublesome symptoms might empower women to manage menopause with greater confidence,” Hickey said.
More than 75% of women experiencing the menopause report symptoms, with roughly a quarter describing them as severe. Although some women benefit from hormone therapy, dietary changes, regular exercise, quitting smoking and finding ways to reduce stress can also help.
Haitham Hamoda, the chair of the British Menopause Society, and the society’s chief executive, Sara Moger, wrote in a related editorial: “Healthcare providers should take an individualised approach to assessment, and empower women to make informed decisions based on unbiased, evidencebased information applied effectively.”
Although the benefits of hormone replacement therapy (HRT) were likely to outweigh the risks for most women with problematic symptoms, current evidence did not support its use to prevent dementia or cardiovascular disease, and it should not be prescribed without a clear indication, they said.
Dr Rammya Mathew, a BMJ columnist, added that recent criticism of GPs by the TV presenter Davina McCall in her documentary series about the menopause was feeding into a narrative that the country’s GPs were underskilled and underqualified and so failing women.
She said: “The more nuanced truth is that many U-turns have been made regarding the safety of HRT, which have had a lasting impact on practitioners’ confidence in the available evidence. Women’s symptoms can’t always be attributed to the menopause, and although the benefits of HRT outweigh the risks in most women, this is not always the case.“I don’t deny that individual women have been let down, and I applaud Davina for raising awareness of what’s often still considered a taboo subject in society. But the point about GPs’ competence needs to be challenged.”