Confused about menopause?
Menopause was once rarely mentioned in public. Now if you’re a woman over 35, your social media feeds are likely plastered with ads for menopause clothing, menopause moisturiser and a plethora of dubious supplements.
For some women perimenopause (the time of hormonal change leading up to menopause) can be tough, perhaps the worst experience of their life. But for others, it’s a blip that can be navigated more easily, alone or with naturopathic help.
How many women experience severe menopausal symptoms?
Data on the severity of peri/menopausal (the time immediately before, during and after menopause) symptoms varies widely, with figures of 10 – 25% of women experiencing intrusive to severe peri/menopause symptoms. While a similar number at the other end of the spectrum report few or no negative symptoms. Most women fall in the middle, having episodes of flushing, insomnia or other interruptions to daily life but overall finding the transition manageable without medication.
However recent research shows that problems can arise if women only hear horror stories. Studies have found a connection between exposure to predominantly negative stories and experiencing a more challenging time during perimenopause.
Stigma, embarrassment, a lack of public awareness, and miscommunication mean that for many women, menopause is either borne in quiet suffering or else over-medicalised as nothing more than a hormone deficiency requiring oestrogen replacement.
The Lancet
Are women being sold a problem?
Menopause is now a huge industry. The market size by 2030 is projected to be US$600 billion. While Femtech is a fast-growing sector, established players like the pharmaceutical industry are raking it in with US$16.93 billion in menopause-related sales alone in 2023.
In order for the market to grow, we need to be sold the problem. While it’s important that women are aware of the signs and symptoms of the perimenopause, the narrative has been dominated by negativity and over-medicalisation.
A recent Lancet series on menopause sparked controversy by claiming menopause is being over-medicalised. However the researchers acknowledged that up to 25% of women could experience moderate to severe symptoms that impact their quality of life and may benefit from menopausal hormone therapy (MHT, previously known as hormone replacement therapy (HRT). But they called for a more balanced and empowered approach to managing menopause and cautioned against promoting MHT as a panacea.
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.”
Professor Martha Hickey, University of Melbourne and Royal Women’s Hospital, co-author of the Lancet series on menopause
There are many criticisms of the recent Lancet series, especially the accusation of over-medicalising menopause. Industry organisations have slammed the series, including the Australasian Menopause Society, arguing that it underplays the importance of MHT in both symptom management and as a preventative strategy.
The HRT/MHT controversy
Hormone treatment for peri/menopausal symptoms has been controversial since the Women’s Health Initiative prematurely stopped it’s HRT study in 2002 due to identifying an increase in breast cancer in the combined oestrogen and progestin arm of the trial.
As a result HRT use dropped by 46% in the US alone. It took at least a decade for sales to bounce back. Along the way, the tainted name HRT was replaced by MHT – a common practice when a product is mired in controversy!
Conflicting information about MHT/HRT
Cancer risk
Central to much of the debate around the safety and effectiveness of MHT is the different degrees of risk associated with the two most common types of MHT – oestrogen and progestin (previously called combined HRT) and oestrogen-only. Oestrogen alone is prescribed only to women who’ve had a hysterectomy (ie have had their uterus removed) as it can significantly increase the risk of endometrial cancer.
However, as most women currently prescribed MHT still have a uterus, they’re given the combined form. This is the hormone combination is still associated with the slight increased risk of breast cancer. Though debate about cancer risk continues regarding the form of progesterone/progestin used and how long to safely use it.
So while it’s now often quoted that MHT doesn’t increase the risk of breast cancer, this is true for the smaller percentage of users prescribed the oestrogen-only drug. The slight increase in breast and ovarian (which rarely is mentioned) cancers remains for women taking the most commonly prescribed type of combined MHT.
What’s a ‘slight risk’? According to a recent article in the BMJ, it’s about six additional cases of breast cancer per 10,000 women aged between 50 -59 yo taking combined MHT each year.
MHT a panacea?
So is the “new” MHT (which is in effect the old HRT with a different name) a panacea for all hormonal and midlife maladies? Current evidence has validated some claims but disputed many others.
While MHT is associated with reduced hot flushes and bone fractures, a Cochrane review found an associated increased risk in heart attacks, deep vein thrombosis, stroke, breast cancer, gall bladder disease and death from lung cancer. It also challenged claims that MHT reduced incidence of dementia and cognitive decline .
Debate continues to surround when women should start taking MHT if needed and for how long, also the best way to administer it (tablets, creams, patches etc). Likewise the safety and efficacy of newer drugs in the menopause market including tibolone and Fezolinetant.
If eminent researchers can’t 100% agree, it’s no wonder women are confused!
As a naturopath I see women in different parts of the symptom spectrum. The most intrusive symptoms often go along with times when people are living with prolonged stress and feel like there’s nothing they can do to improve the situation. Perimenopause shines a light in the cracks of our lives and magnifies the issues. If we’re not sleeping well due to hot or wet flushes, it makes dealing with everything so much more challenging.
Panaceas, natural or pharmaceutical, don’t exist. As we’re individuals, one size never fits all but there are holistic solutions offered by experienced practitioners that can help many women, which may be worth trying first. For personalised support with menopause or general health please book your consultation with Gill online . Gill works via Zoom with women around Australia and New Zealand.
Read more about menopause.
Update June 2024: Annual meeting of the American Society of Clinical Oncology
Two decades after the landmark Women’s Health Initiative (WHI) changed the way clinicians thought about hormone therapy and cancer, new findings suggest this national health study is “the gift that keeps on giving.”
Ovarian Cancer Risk Doubled by Estrogen-Only HRT
This is new research, using data from the 90s. Current clinical guidelines for prescribing HRT is that combined (oestrogen and progesterone/progestogen) is used only if you have a uterus, to decrease the known risk of developing uterine cancer. Women post-hysterectomy are prescribed oestrogen alone.
There is so much controversy around HRT, for an ovarian cancer survivor especially younger women diagnosed with OC, it raises so many questions.
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