Night sweats. Mood swings. Insomnia. Hot flashes. Weight gain. Headache. Depression. Worry. Palpitations. Joint Symptoms. . . I can continue.
It’s a grim list, right? Yet these are just some of the menopause side effects.
You would undoubtedly assume that a combination of such symptoms in women in their 40s and 50s would be sufficient to at least arouse the interest of a physician and put them into action.
Well, you would be wrong. As the e-mail reported yesterday, too many women who are approaching or undergoing the change of life are being ignored, given away by their doctors or given a ‘plaster’ prescription for antidepressants.
As the email reported yesterday, too many women approaching or undergoing the change of life are being ignored, kicked off by their GPs, or given a ‘patch’ prescription for antidepressants
About 13 million British women are in transition – but according to a 1500 survey for the influential online forums Mumsnet and Gransnet, one in four must visit his doctor at least three times before he receives appropriate treatment, including HRT.
This is an absolute scandal.
The menopause is defined as when normal monthly periods stop. The average age for this is 51. But the symptoms may begin a few months or years before, in the so-called perimenopause, when estrogen and progesterone levels begin to fluctuate.
At a time when many more people – men and women – have been better informed than ever about the possible consequences of the menopause, when it is considered ‘OK’ to talk about it publicly and there are even campaigns to recognize it in the workplace , I see it as a disgraceful betrayal by the medical institution of those women who find it difficult to deal with.
You can be sure that if it were men who had to deal with such symptoms, delays in access to treatment would not be a problem.
What is worse, when some women finally receive therapeutic help, this is often the wrong treatment.
The most common menopause symptoms, such as anxiety or palpitations, are too often dismissed as “psychological” and patients are given antidepressants – the medical equivalent of a patronizing pat on the knee.
I have seen this several times in my own clinics. Women have been referred to me because they are depressed, but when you listen to what they say, it soon becomes clear that their difficulties are the result of the menopause.
Mindfulness and meditation techniques can often help with hot flashes. But for some women there is no doubt that the symptoms can profoundly affect their lives and HRT can be a solution
One patient I saw took antidepressants, a beta-blocker to treat palpitations (attributed to anxiety) and a highly addictive medication for anxiety. She had tried to tell her doctor that the symptoms had occurred while going through the menopause. He ignored her.
She asked for HRT, but he refused to prescribe it and refused to give a satisfactory reason why.
She was so convinced that her symptoms were a direct result of hormonal changes that she went private to get HRT. Within a few months of the onset, her depression and anxiety had disappeared, she was able to stop all other medications and did not have to see me again.
I am a passionate advocate of the NHS, but something is completely wrong here. GPs are the crucial gatekeepers of health care, but it is simply wrong to refuse a series of treatments to women whose lives could be changed by them.
The menopause is of course a natural phenomenon. It is not a disease and should not be considered as such. HRT is also not suitable for everyone.
Sometimes the best treatment for menopause is as simple as painkillers for frequent headaches or joint problems. Mindfulness and meditation techniques can often help with hot flashes. But for some women there is no doubt that the symptoms can profoundly affect their lives and HRT can be a solution.
So why do they find it so difficult to gain access to it? It is not just a production and delivery problem for certain brands, although it has caused problems in the last six months.
The British Menopause Society and other organizations have provided detailed guidelines for “equivalent doses” so that doctors can switch prescriptions to brands that are locally in stock if needed.
But the struggle to access HRT dates back to these problems and the reasons for it must concern us all.
I believe it is due to a poisonous combination of women’s hatred, ageism and ignorance.
Too many older male doctors just don’t listen to older women, or they don’t take their concerns seriously.
This is the result of an unconscious tendency in a society that values the young female body and shuns away from the aging female body.
Sometimes the best treatment for menopause is as simple as painkillers for frequent headaches or joint problems
An unforgivable failure to update oneself about the pros and cons of HRT is also a factor. Many doctors are reluctant to prescribe HRT because they are wary of the safety profile.
This stems from a number of studies over the years that link the use of HRT to some forms of cancer, especially breast cancer.
HST was initially announced as a panacea for the problems of women of a certain age. But over the past 20 years, the pendulum has swung dramatically the other way and there has been almost relentless negative publicity.
These bleak studies are quoted in every gynecological handbook and there is no doubt that they have colored the opinion of generations of doctors and have made some of them very reluctant to prescribe it.
But we must balance these risks with the effect of menopause on women’s mental health.
Antidepressants, if properly prescribed, can be life-saving, but HRT can be more effective in menopausal women.
And the benefits of HRT are routinely underestimated. They include the reduced risk of fractures due to osteoporosis and reduced rates of heart disease and colon cancer.
The problems are exacerbated by the fact that many older women still have a strong preference for doctors. They don’t want to be seen to cause a fuss or to make a scene.
Then there is ignorance among doctors. I have learned little about the menopause at the medical school, except for a short lecture on HRT in the second year, in which only the risks were highlighted. There was not much attention for the symptoms of the menopause.
And that was it then. Things have undoubtedly changed – but I would bet that medical students today would learn much more from watching breakfast television and shows such as Loose Women.
Knowledge of perimenopause – the early stages of menopause – is even more limited among doctors, with campaigners saying that doctors mistakenly assume that women are too young to experience such symptoms.
Yet this is the time that HRT can be particularly useful because it can regulate hormonal fluctuations.
All this leads to a very unsatisfactory situation in which women in desperate need of help are abandoned.
From the quarter that has to return to their doctor again and again until their pleas have been heard, I wonder how many people just give up, convinced that there is nothing that can help them, that no one cares about them or is willing to listen, and that they must suffer in silence. We doctors must begin to listen.
This content was originally published here.