DR MAX PEMBERTON: This is one of the reasons why women feel anxious during menopause… and HRT won’t solve the problem

Fortunately, there has been a significant change in the attitude of many doctors toward hormone replacement therapy (HRT). It will come as no surprise to most women reading this that, for too many years, peri- and post-menopausal women have had to fight for their right to access this medication.

Finally, an increasing number of doctors are open to the idea that prescribing HRT can have real benefits for their patients and, without a doubt, for many women this has made a life-changing difference.

Although 13 million women in the UK are going through menopause, it is estimated that one in four have to visit their GP at least three times before receiving appropriate treatment.

Last year’s official draft guidance which advised GPs to consider alternative treatments such as talking therapies “alongside or as an alternative to” HRT to help reduce menopausal symptoms such as insomnia, low mood and hot flashes, have now been reviewed.

Health officials backtracked following accusations of “medical misogyny,” with the implication that menopause symptoms were “all in the mind.”

In fact, this week NICE changed its guidance and recommended that HRT should be offered as a first line of treatment.

You might think this is a positive development, but I’m not sure. Regular readers will know that I am a big fan of HRT and have seen many patients’ lives transformed by it, but HRT is not suitable for everyone and talking therapies can help women who present with symptoms that have a psychological component. .

For example, many women talk about not feeling like themselves anymore, about a disconcerting sense that something has changed; a vague undercurrent of restlessness, despair and confusion.

But what causes all this turmoil? Can this simply be attributed to a drop in hormones that is addressed by HRT? Can we explain a woman’s dissatisfaction with life and her sense of loss and discomfort as a chemical reaction? I honestly don’t believe it.

I think it’s much more complicated than that.

That’s not to say that hormones don’t play an important role, and this is one of the reasons I’m a supporter of HRT. We know that hormonal fluctuations can be directly responsible for bad moods.

Over the years, I have seen too many women struggling to cope and for whom HRT has been a blessing, helping them manage anxiety caused by menopause.

But I do believe that there are other factors that contribute to a woman’s sense of loss of self. I firmly believe that low mood and anxiety are the result of complex social and psychological factors, rather than simple biology.

Changes in the body, sleep disturbances, hot flashes, etc., can make any woman feel depressed and out of control.

But there are other issues I’ve heard women talk about: for example, erratic mood swings and unusual behavior. I’ve heard stories of women who had affairs, quit their jobs, or left their husbands around menopause.

While some would try to blame all of this on fluctuations in hormone levels, the evidence is actually not that compelling.

It’s not entirely clear that drops in estrogen and progesterone, the female sex hormones that begin to decline at menopause, are entirely responsible.

Instead, I think menopause acts like a ticking clock. Suddenly, it makes women open their eyes and review their lives.

I believe that much of the trauma and emotional turmoil that plagues many women as they go through menopause is not a result of hormonal fluctuation but rather a reevaluation of their situation.

For many, their sense of self and identity is closely tied to their roles within their family, particularly those who are mothers, who may feel heartbroken at the prospect of an empty nest.

It is also a cruel aspect of the inequality between the sexes that women have to face in a society that is more judgmental about how women age than men.

Many women in their 50s and 60s have given the best years of their lives to other people and their careers, and now they’re not sure why.

They feel like they are invisible now. Many menopausal and postmenopausal women have attended my clinics and told me that they no longer feel like women. It’s incredibly sad.

These people would surely benefit from having the time and space to explore and discuss their feelings and situation. That’s where talking therapies can play a vital role for many desperately unhappy people.

In my opinion, the answer to many complex problems precipitated by menopause will not always be found in HRT pills, patches and gels.

I know why Coleen is so worried.

Coleen Rooney, who is rumored to be heading into the I’m A Celeb jungle this Sunday, has been through a lot over the years. From Wagatha Christie’s affair with fellow WAG Rebekah Vardy to her husband Wayne’s infidelity scandals, it must have all taken its toll.

So it was no surprise to learn that Coleen has reactive arthritis, which is caused by an infection but can also be triggered or worsened by stress. Victims have pain in one or more joints that can affect their mobility and mental health. “It caused anxiety and there were a lot of tears,” Coleen said, speaking about the condition. “It wasn’t a nice place to be.”

My mother developed reactive arthritis after a bout of food poisoning. While awaiting knee replacement surgery, his world shrank with pain. It can rob you of your independence and your sense of joy.

The Advertising Standards Agency has issued a warning to a GP after he misled patients about the level of training associate doctors (or assistants, as I call them) have had.

The GP practice’s website states that PAs “are trained and examined in all areas of medicine” and that the training “covers medication and prescribing, just as a junior doctor would receive”.

In fact, PAs are not trained in all areas of medicine and surgery has been warned not to combine the functions, training and duties of PAs and GPs. The worrying thing is that this is not an isolated incident and appears to be an attempt to mislead the public.

In Bradford, a series of posters designed to show the range of healthcare workers in GP surgeries used words such as “doctor” and “cancer specialist” to describe PAs. This is embarrassing and only causes confusion among the public.

Few doctors other than consultant oncology would ever dare to describe themselves as “cancer specialists”. How is it okay for people who aren’t even doctors to do this? Is it any wonder people feel confused about whether they’ve actually visited a doctor or not when there are ads like these?