A recent piece in the UK’s The Times suggested celebrities sharing stories of their perimenopause and menopause symptoms is causing over-medicalisation of the life stage and its effects.
Apparently, Davina McCall and her cohorts being open and honest about night sweats, brain fog, mood swings and anxiety having a negative effect on their lives is sending women racing to their doctors, demanding oestrogen gel in their droves. But is this really the case? Or is it simply that as 40- or 50-something women, we’re just not prepared to put up with feeling rubbish during this life stage any more?
According to a report in medical journal The Lancet, HRT prescriptions did indeed soar 60 per cent in the UK between 2020 and 2022. The same report also concluded there’s no compelling evidence to support the view that menopause increases the risk of such mental health conditions. Clearly, it’s all up for debate.
Dr Amber Syed, specialist gynaecologist at Mediclinic, agrees there is indeed much more awareness nowadays of perimenopause and menopause - and the effects on quality of life – and some of this is due to celebrities and influencers discussing the subject. “Women are more open to talking about a subject that’s generally been considered taboo over the years,” she says. “Whether that’s a good or bad thing depends on various factors, but opening the subject up for discussion can only be positive.”
Dr Tamara Aldawery, a family medicine consultant based at GMC Clinics, says the rise in HRT prescriptions could simply be attributed to the number of women seeking help for symptoms, rather than suffering in silence. “I see the uptick in HRT prescriptions as likely indicative of just how many women suffer with symptoms, rather than an overprescribing situation,” she explains.
And, she says, women have a right to seek help if they’re suffering and they feel their symptoms could be hormonal. “If a woman has had enough of symptoms affecting her daily life, and she’s worried they could be perimenopausal or menopausal symptoms, then it’s absolutely her right to get a medical opinion,” she continues.
Dr Amber agrees. “The severity of symptoms of perimenopause or menopause is determined by the woman, not by the doctor,” she says. “It’s the doctor’s responsibility to listen to the woman, to assess her concerns and the effects [her symptoms] are having on her life.”
It’s vital to have an open discussion about the advantages or disadvantages of any treatment options, including HRT, says Dr Amber, and care has to be individualised; it’s never a ‘one size fits all’ treatment.
But what of HRT’s reputation as risky, especially if taken over an extended period of time? Modern treatments such as body-identical HRT are a world away from those originally used, says Dr Tamara, and as long as major risks are considered, then HRT is safer than ever. “The main issues to check are that no major history of cancer exists, or blood clots, or liver disease, as these increase the risk of taking HRT,” Dr Tamara explains.
Dr Amber says HRT is no different to any other medical treatment in that there will always be side effects, but absolute contraindications would include a history of breast or other oestrogen-based cancer, active deep-vein thrombosis or a blood-clotting disorder.
Side effects such as bloating, nausea, drowsiness, breast tenderness and weight gain can be managed by dose and route alteration, says Dr Tamara.
Dr Yaseen Aslam – consultant psychiatrist and Medical Director at The Psychiatry and Therapy Centre, says it’s important to consult with the relevant specialists if you’re concerned about mental wellbeing symptoms at an age where perimenopause or menopause could be the cause. “Perimenopause and menopause lead to significant hormonal changes for women, which can result in a number of significant emotional and psychological symptoms including mood changes, depression, anxiety, irritability, memory problems, sleep disturbance, fatigue and panic attacks,” he explains.
Evidence exists that shows HRT can help, he says, but treatment should always be on a case-by-case basis and patients must be assisted by qualified clinicians to determine whether the symptoms are indicative of a primary mood disorder, such as a depressive illness, or as a consequence of underlying hormonal issues.
So, should those in the limelight continue to talk about perimenopause and menopause, or are they influencing too many women into believing they’re suffering? Dr Tamara says anyone in a position of influence could help millions and if they can, they should. “It’s vital for women to be aware of what can happen during perimenopause and menopause. We’re all going to go through it at some point, and any and all awareness of it is a good thing.”
Dr Amber agrees awareness can only be a positive, but it’s what we – and the medical professionals with whom we consult – do with this awareness that’s key. “I’d like to believe that medical professionals would have carried out due diligence before prescribing HRT; it’s not available without a prescription, and that’s a good thing.”