HRT – hormone replacement therapy – is hardly out of the news.
From falling out of favor in the early 2000s, its rise in the past few years has been unstoppable – in 2022-2023 the NHS dispensed 47 per cent more HRT prescriptions than the previous year.
It’s hardly a surprise, given the amount of publicity, celebrities on TV and social media, and the claims about it. There is no doubt that HRT is a very effective treatment for the classic menopausal symptoms such as hot flashes and night sweats. But social media pledges go far beyond that.
They offer great skin, ‘vitality’, ‘new energy’, relief from anxiety, ‘brain fog’, muscle pain and fatigue. Instagram is full of mid-life women who look amazing and support HRT. Closer to home, presenter Davina McCall has said that being on HRT ‘will give me a bit more protection (against Alzheimer’s) than it would if I wasn’t on it’.
The subliminal message is that menopause is a medical problem and needs to be treated.
In 2022-2023, the NHS dispensed 47 per cent more HRT prescriptions than the previous year (Stock Image)
Now a series of articles in The Lancet, by a group of prominent women’s health researchers, have called for more nuance about menopause and the ways we treat it.
Even the name “hormone replacement therapy” implies that women are deficient – researchers refer to it as “menopausal hormone therapy”.
Significantly, they say that “commercial companies and individuals with vested interests have over-medicated menopause” and that “the framing of this natural transition period as an estrogen-deficiency disease that can only be alleviated by replacing the missing hormones fuels to negative attitudes towards menopause and exacerbates stigma’.
I have to agree. I remember years ago women were rightly annoyed when told by their doctors that every single symptom they had was due to ‘their hormones’ when in fact they had other conditions that were not being investigated. We seem to have come full circle.
Some women clearly have a severe menopause with severe and multiple symptoms and experience great benefit from HRT.
Speaker Davina McCall has said that being on HRT ‘will in a way give me a bit more protection (against Alzheimer’s) than it would if I wasn’t’
But there are also women who are disappointed with it and find that it does not live up to some of the claims on social media.
There are also plenty of other women who don’t feel the need for any treatment or who can’t take HRT (eg women with breast cancer) who wonder if they’re dooming themselves to dementia or a heart attack by not putting on the patches.
The question is how to ensure that women receive high-quality information that is not biased or over-promising what HRT can provide.
Last year, following its own inquiry, the All-Party Parliamentary Group (APPG) on Menopause published a manifesto. It included a call to financially incentivize GPs to diagnose menopause and to license a female-specific testosterone (currently women who are prescribed testosterone have it on an off-label basis as there is no female-specific product licensed in Great Britain).
But financial incentives for diagnosis can have unintended consequences, such as ‘diagnostic overshadowing’ where other conditions are not fairly considered.
And imagine thinking that your doctor only considered diagnosing menopause to make money off of your diagnosis.
There are women who are disappointed with HRT and find that it does not live up to some of the claims on social media (Stock Image)
On testosterone, the APPG said there is “some evidence” that it will treat fatigue and “brain fog” – but an independent review in 2019 found no evidence for this. It came as no surprise to me that the APPG’s inquiry and manifesto were funded by pharmaceutical companies – including Astellas, Bayer and Theramex, which either manufacture or develop menopausal drugs – with both investigated by Dentons Global Advisors (which has several pharmaceuticals). . customers).
None of this means that HRT doesn’t work, but it risks women being oversold a treatment that comes with the risk of side effects and won’t do what is promised.
Menopause can end up being presented as a simple problem to be solved—a menopausal woman lacks hormones and therefore needs them replaced—rather than a complex, nuanced picture (some women will benefit from hormones, others will not; some symptoms may be caused by menopause, others not; some women will have few symptoms, others will not).
Take the backlash on social media to draft guidance on menopause issued last year when the National Institute for Health and Care Excellence (NICE) suggested cognitive behavioral therapy (CBT) could help some women manage symptoms. This gave rise to complaints that symptoms were dismissed as ‘all in the mind’.
Still, there’s good evidence that many women find CBT useful: it’s already used for other conditions, including chronic pain, and is about giving people useful ways to manage symptoms – without saying that their very real symptoms ‘just ‘ are psychological.
There should be room for choice in evidence-based approaches, but the current HRT-menopause axis does not allow this.
Meanwhile, it’s clear that menopause is driving a growing industry eager to sell products supposedly designed for women in their fifties. Instagram is full of nutritional supplements, skin and hair care products that all claim to provide menopause benefits.
I have spoken to several young women who view the coverage with quiet dread, afraid that their menopause is coming.
Dr. McCartney believes that “there should be room for choice in evidence-based approaches, but the current HRT-menopause axis does not allow this” (Stock Image)
Yes, some women feel terrible. But we owe it to women of all ages to make it clear that for some it is a liberation, free of periods and the need for birth control – and for others the symptoms are mild and it is rather a non-event.
Women are still losing out – we may have more ‘awareness’ about menopause, but I don’t think this has come with better information.
So how do we make better choices? Seek independent information – from organizations that don’t have vested interests, aren’t funded by medicine, and don’t want to make money by selling you stuff.
I’m also looking for information where I can see the pros and cons fairly – miracle cures don’t exist.
Finding your way through hype and sales pitches is not for the faint of heart, but if ever there was a need to try to find unbiased medical advice, this is it.
Dr. McCartney is a general practitioner in Glasgow and a senior lecturer at the University of St. Andrews.