Does Australia need to treat menopause differently? The question that sparked a women’s health debate
From when she was about 45, Rachel Angus experienced a range of debilitating health issues.
Her joints ached. She would double over from the pain in her uterus and ovaries. She wasn’t sleeping and constantly felt lethargic.
One of the most challenging symptoms for the funeral celebrant was frequent hot flushes.
“I would go beetroot red in the face, profusely start to sweat and there I am, standing in front of 300 people,” she said.
For nearly three years she saw her GP trying to work out what was wrong.
Not once did her doctor suggest what she was experiencing could be related to the drop in reproductive hormones that happens during menopause.
When she happened to see a fill-in GP, he suggested she try menopausal hormone therapy (MHT) also known as hormone replacement therapy (HRT).
Six weeks later, her symptoms had resolved.
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Has menopause become ‘over-medicalised’?
The hormone therapy Rachel received is a common solution for people experiencing adverse symptoms during menopause.
But a group of Australian researchers has today argued in prominent medical journal The Lancet, that menopause is being over-medicalised and treatment options are too simplistic, narrow, and often swayed by commercial interests.
“One problem is that a normal event that affects [women] has been turned into a disease, a hormone deficiency disease, which requires diagnosis and treatment,” said lead author Martha Hickey, from the Department of Obstetrics and Gynaecology at the University of Melbourne.
Hormone replacement therapies (HRT) are one of the most common treatment options for people experiencing adverse symptoms during menopause or perimenopause.
Professor Hickey thinks HRT should be available for those who need it — for example, to address problematic hot flushes and night sweats.
She argues the therapy should not be seen as a “solve all”, and that the risks of taking the medication need to be weighed against its benefits.
In her view, doctors should discuss alternative treatments, such as cognitive behaviour therapy and lifestyle changes to improve sleep and mood.
“This model of medicalisation of menopause is actively disempowering for women,” she said.
“It suggests that when you’re older, you’re just an oestrogen-starved younger women, and also that aging itself is synonymous with being unhealthy.”
She’s one of several researchers calling for an overhaul of the way menopause is seen and for a broader approach to treating symptoms.
Their views are featured in a series of four literature reviews or opinion pieces published in the latest edition of the The Lancet.
Not everyone agrees with ‘disease’ statement
Leading Australian researchers involved in the treatment of menopause symptoms worry some of the ideas expressed in the papers could make it harder for women to get the help they need.
One of them is psychiatrist Jayashri Kulkarni. She agrees that menopause should not be treated like an “illness”, but also points out that many women suffer terribly during that phase of their life.
In her clinical work, every day she treats women who struggle with severe depression, anxiety and brain fog caused by hormone fluctuations.
Professor Kulkarni says those women should be told what therapies are available so they can choose how to address their symptoms.
She doesn’t accept the argument that menopause should be considered a normal part of aging and that clinicians prescribing MHT are contributing to the stigmatisation of that phase in women’s lives.
“Death is a normal part of life, but it’s something we want to avoid,” she said.
Before she was put on MHT, Rachel Angus, now 50, said she had blood tests, endoscopies and, in her words, every other “oscopy” known to man.
“I actually didn’t require any of those things,” she said.
She now considers those tests an example of over-medicalisation and says all she needed was to have her hormone levels addressed.
Endocrinologist Susan Davis, a professor at Monash University, says rather than being over-medicalised, most women experiencing troubling menopausal symptoms find it difficult to get treatment.
Most women will get through menopause without any issues but one in three will struggle, she added.
“They need care,” she said.
Professor Davis would like to see an approach to menopause care that accepts some women will need medical help to address their symptoms and cautioned against stigmatising them for that.
She likened the opposition to MHT to opposing pain relief for women in childbirth.
“I think neutral language, compassion, acceptance, understanding everybody’s different is really important,” she said.
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What is The Lancet’s series on menopause?
The series is made up of four papers and is a mixture of opinion and analysis of past research.
In the first piece, Professor Hickey argues that women should be empowered to navigate menopause, in part by having access to factual information “that is free from the influence of pharmaceutical companies and commercial entities who are trying to sell them something”.
She worries the overall approach to menopause is driven by stigma, sexism, and ageism.
The second paper examines the health impacts of early menopause, including an increased risk of cardiovascular disease and osteoporosis.
The paper concluded that gaps in both research and clinical diagnosis guidelines meant those who experience early menopause didn’t receive optimal care and were given little advice on how to manage it.
The third paper investigated mental health and menopause and argued there was little evidence to show women going through menopause were at a heightened risk of anxiety, bipolar disorder, or psychiatric disorders.
The fourth looked at the difficulties of managing menopause during and after cancer and highlighted gaps in the management and role of MHT.
Overall, the researchers uses the series to call for a societal change in the way menopause and aging were viewed.
“Changing the narrative to view menopause as part of healthy aging may better empower women to navigate this life stage and reduce fear and trepidation amongst those who have yet to experience it,” Professor Hickey said.
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