Last week’s controversial BBC Panorama episode, The Menopause Industry Uncovered, came as a shock to many.
The first half of the 30-minute film raised concerns over expensive menopause supplements being sold in the UK, despite having no clear benefit.
However, the second part of the documentary was more worrying. It alleged that some private menopause doctors are putting the health of women at-risk by prescribing extremely high doses of HRT. The show focused on one specialist and her clinic in particular – the celebrity menopause guru Dr Louise Newson.
HRT pills can play an important role in tackling symptoms of the menopause
According to Panorama, her private practice – The Newson Clinic – is prescribing one in five of its patients with doses of HRT well above the recommended limits.
Dr Newson and her colleagues claim these high doses are necessary to control the debilitating symptoms triggered by hormonal changes, including hot flushes, disrupted sleep, and mental health problems. But Panorama highlighted 12 cases of women who claimed they had been harmed by the medication.
As a GP with an interest in women’s health, I am disappointed by the revelations but not surprised.
I’ll say no more about that specific case, and the hospital watchdog the Care Quality Commission is now investigating. But I’ve long been concerned about the over-medicalisation of the menopause – and a small but vocal group of campaigners who claim it’s not simply a normal stage in a woman’s life, but a disease or ‘deficiency’ that needs treating.
It’s an issue I touch on in my book, The Science Of Menopause, published this week. Because while I understand the theory, I couldn’t disagree with it more.
It cements the idea that we are ‘broken’ and lacking, when the menopause is a normal, expected part of getting older.
That’s not to say that I’m against HRT – I’m not.
Women’s lives can be destroyed by menopause symptoms. They can ruin careers, trigger relationship breakdowns and divorce, and have a catastrophic impact on mental health. One in ten women consider suicide as a result.
Last week, new data showed 60,000 women are off work long-term due to menopause symptoms. For many of these patients, HRT can be transformative.
Menopause used to be something that was never talked about. I’m grateful that, thanks to celebrities and campaigners – including Dr Newson – that has changed.
It means those who suffer are more likely to get the medical help that they need.
But, like many colleagues, I think the pendulum has swung too far. The truth is that not every woman needs HRT.
The idea of the menopause being a disease isn’t new – it dates back to the 1960s.
A bestselling book published in 1966, called Feminine Forever, by Robert Wilson, outlined the concept. The British-born, US-based gynaecologist claimed the menopause was a hormone deficiency, which was ‘curable and totally preventable… just take oestrogen’.
HRT, Wilson argued, was not simply helpful but necessary in order to free women from the ‘curse’ of oestrogen loss. He believed that it should be taken for life, not just until the symptoms subsided.
Dr Louise Newson’s clinic is prescribing one in five of its patients with doses of HRT well above the recommended limits
‘Many physicians,’ Wilson wrote, ‘simply refuse to recognise menopause for what it is – a serious, painful and often crippling disease.’
For anyone even slightly persuaded by this, he also wrote that with HRT, a woman’s ‘breasts and genital organs will not shrivel. She will be much more pleasant to
live with and will not become dull and unattractive.’
Clearly, this is misogynistic claptrap. It plays to the idea that women are mainly valued for their looks, sexual availability and ability to bear children.
But, astonishingly, today’s social media era has given this dreadful concept new life.
This time it’s been rebranded as women taking control of their midlife health in an empowering way. Some of these campaigners and celebrities promote dodgy supplements and fad diets that are supposed to help menopausal women ‘turn back the clock’. Others advocate taking testosterone – the ‘male’ sex hormone that women also have in smaller amounts – to boost libidos and improve mood, concentration and sleep.
The British Menopause Society recommends testosterone only to tackle low libido – and only in cases where other treatment options have been exhausted.
It has made HRT almost trendy – the latest anti-ageing product.
Like most GPs, I regularly get requests for HRT from women in their 40s and 50s who don’t have any menopausal symptoms.
Midlife can be messy for women, whether it’s menopause symptoms, which can be crippling, or just the stress of juggling busy careers, teenage children, relationships and ailing parents – all on top of the normal process of ageing.
Some challenges are hormonal, and if they are then HRT will help.
But while it can fix some of these symptoms related to hormone levels, it won’t fix everything. And it’s vital women don’t have unrealistic expectations about what the treatment can do.
If you’re on the maximum licensed dose of HRT, and you’re still having symptoms, the solution may be to look at what else might be causing them and considering adding other treatment – such as antidepressants or talking therapy – rather than increasing the dose further.
For me, empowerment isn’t about feeling you have to be doing something, but about having a choice over what you do.
Menopause isn’t one-size-fits-all. Like any life stage, every woman will experience it differently.
For some, simple lifestyle changes – a healthier diet and being more active – really does help. For the one in four who experience severe and debilitating symptoms, HRT plays an important role. Modern forms, available as gels, sprays and patches, rather than older-style pills, are safer than ever.
We have good evidence that, for women who need it and can take HRT, the huge benefits outweigh the small risk of breast cancer or blood clots.
But there is not enough evidence, unless you went through early or surgical menopause, that HRT will protect you against heart disease or dementia – regardless of what you might read on social media.
Claims such as these just provoke fear among women who can’t take HRT because they have a history of breast cancer or other serious health problems.
Rather than being told they’re broken, or have a disease that needs treating, women need to know they have choices.
I am often asked if I am pro or against HRT. It feels an odd question. Crucially, I am pro what helps my patients – and the solution isn’t always HRT.
The Science Of Menopause, by Dr Philippa Kaye, is published on Thursday (DK, £16.99).
