Intended for healthcare professionals

Rapid response to:

Analysis

Normalising menopause

BMJ 2022; 377 doi: https://doi.org/10.1136/bmj-2021-069369 (Published 15 June 2022) Cite this as: BMJ 2022;377:e069369

Rapid Response:

Re: Normalising menopause

Dear Editor

We are appalled and quite frankly saddened to read this article that is peddling a very dangerous narrative – that because menopause is a ‘natural’ part of the ageing process, that women should avoid any medical treatments. The core of the problem is women’s choice. For too long women have not being listened to, they have been undermined and belittled, they are being told to put up with symptoms that can lead to women leaving their jobs, partners and suffering with horrendous symptoms affecting their quality of lives. The menopause is known to be associated with an increased risk of important diseases including heart disease, diabetes, clinical depression, osteoporosis, dementia and early death. Also for many women the menopause is not “natural” as it occurs due to surgery to remove ovaries or damage to the ovaries from drugs or radiotherapy. Many young women experience menopause which is known to be associated with an even greater risk of developing these diseases.

It is vital that the menopause is recognised as a female hormone deficiency with health risks and not simply a lifestyle change that doesn’t need medication. Menopause care should be holistic – HRT is not the only treatment we give as menopause specialists, we also give nutrition, lifestyle, exercise, wellbeing, psychological advice – but the fundamental thing that women should be offered is choice. If we want to promote choice, we have to start with the ingrained misconceptions and prejudices that surrounds women’s health.

Just because something occurs ‘naturally’ doesn’t make it good. This is a version of the naturalistic fallacy, applied to over a billion menopausal women worldwide.

We often see the same thing in the objection to ‘medicalising birth’. Yes pregnancy is a beautiful natural process, but helping women have safe pregnancies is not medicalising their experience, it reduces their risk and improves outcomes for babies and mothers.

It’s not a coincidence that the medicalising charge is directed against women both when pregnant and when menopausal. Society seems to have a hard time accepting that women are embodied, they are not ethereal beings, that they have medical needs which have to be addressed, funded and provided to ensure equity and ease of access. There is now a generation of women standing up and demanding change. Telling them what they’re experiencing is just normal part of ageing is frankly medical gaslighting.

There is a national HRT shortage as more women are requesting HRT. We have clearly reached a crisis point as the demand by women to receive evidence based treatments has escalated.

Many healthcare professionals are still confused, understandably, about evidence-based menopause care and treatments, including safe HRT prescribing, because there have been so many confusing articles in the medical literature and inadequate menopause education for many. We have already had over 25,000 downloads of our free Confidence in the Menopause education course which was developed by the not-for-profit company, Newson Health Research and Education. This highlights that so many healthcare professionals are keen to learn more which is going to really help improve the future health of women and reduce their suffering.

It is essential that all educators are consistent in their messaging and refer to the recent evidence and research which clearly show that the health benefits of taking HRT are very real and apparent. We certainly are not stating that all women should be forced to take HRT but all women who want to take HRT should be allowed to have it in a very easy and accessible way. They should not have to be fighting to have their own hormones replaced.

Competing interests: Dr Louise Newson is Founder of Newson Health Menopause Society and Director of Newson Health Menopause and Wellbeing Centre. Since opening her menopause clinic in 2018 she has received no money from pharmaceutical companies. She created the not-for-profit company Newson health research and education in 2019. The society was launched last year. We do not do any paid work with any pharmaceutical companies. In addition, our society receives no money from pharmaceutical companies. All the people contributing to this response are associates of the society and have no competing interests.

16 June 2022
Louise R Newson
GP and Menopause Specialist
Lucy Chatwin Director of Newson Health Research and Education Dr Dan Reisel, MBBS DPhil Senior Research Fellow EGA Institute for Women's Health University College London Dr Rebecca Lewis MBBS FRCA DRCOG MRCGP GP and Menopause Specialist Dr Shehnaz Apabhai MRCGP MRCP MBBS MRes Neurosciences GP and Menopause Specialist Dr Tamie Downes MBBS MRCGP DRCOG DFSRH DCH GP and Menopause Specialist Dr Clare Ashby Bsc(Hons) BMBS MRCGP GP and Menopause Specialist Dr Olivia Jones BMBS BMedSci MRCGP DRCOGF Dr Ruth Gibson MBChB MRCGP(Distinction) DRCOG GP and Menopause Specialist, GP Appraiser and Educator Karen Sian Rees RGN MScANP IP Nurse and Menopause Specialist Dr Anna Chiles MBBS MRCGP DRCOG GP and Menopause Specialist Dr Karen O’Reilly MBBS MRCGP FRCGP PG Dip Med Ed GP and Menopause Specialist Dr Lucy Steed MBChB MRCGP DCH DFSRH GP and Menopause Specialist Dr Hollie Jackson MBChB MRCGP DRCOG DFSRH GP and Menopause Specialist Lindsey Lester BSc(Hons) Pharm GPHc Pharmacist and Menopause Specialist Dr Jenny Cusack MBChB MRCGP DFSRH GP and Menopause Specialist
Founder of Newson Health Menopause Society and member of UK Government Menopause Taskforce
Winton House, Church Street, Stratford-upon-Avon. CV37 6HB