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

The article “Normalising Menopause” draws upon outdated research into attitudes to menopause, and fails to take account of the latest science pointing to the incredible long and short-term benefits for women who use body-identical hormone replacement therapy.

The authors cite two small American and Australian studies – one from the 1980s and one from 2003 - showing that women were mostly “relieved” or “not troubled” when going through the menopause “transition”. This is very much not the case in Britain in 2022. As producer of two Davina McCall Channel 4 menopause documentaries, I worked with the Fawcett Society to commission the largest ever diverse study of over 4,000 UK menopausal women, aged 45-55, published in May 2022 (Fawcett Society. Menopause and the workplace. 2022)

A key part of this research was the inclusion of people in perimenopause in their mid-to-late forties, as well as menopause, and the results should give healthcare professionals pause: 84% of respondents suffered from sleeplessness, 73% struggled with brain fog, 70% hot flushes, 69% anxiety and depression and 66% with joint pain. Worryingly, 10% had left their job due to menopause symptoms – 22% for disabled women - and 52% lost confidence at work. Why should this be “normalised” when such suffering is unnecessary for the majority of women who can safely use HRT?

Our poll showed only 14% of women in the UK are using HRT, but of those, half said it had “given them their life back”.

Women’s attitudes to menopause are changing as their medical knowledge grows, and they have realised they no longer have to “keep calm and carry on” when body-identical HRT (usually oestrogen and micronised progesterone) has been shown to be a much safer option. The latest 2022 research in the American College of Obstetrics and Gynaecology journal on “Menopausal Hormone Therapy Formulation and Breast Cancer Risk” (https://pubmed.ncbi.nlm.nih.gov/35675607/) into thousands of women in the UK databank showed no increased risk of breast cancer for those using progesterone rather than synthetic progestins as part of HRT.

This is all good news for women and time-strapped, underfunded GPs who see menopausal patients struggling on repeat visits. In the long run, the outlook is even better. In my research, I dived in detail into the studies showing how much long-term use of HRT reduced the risk of osteoporosis, heart disease, dementia, colon cancer and even cataracts. Our female hormones - oestrogen, progesterone and testosterone – are key to our quality of life as we age. In fact, medicalisation of the menopause is positive for the majority of women. It’s a healthcare and an economic no-brainer, when HRT is cheap, and a hip replacement costs £15,000. Menopause in not a disease, as Martha Hickey and her co-authors correctly point out. It is a long-term hormonal deficiency that we no longer need to unnecessarily endure. Properly treated, the menopause is a powerful portal for women into the productive and healthy second half of their lives. That’s how we need to change the narrative.

Kate Muir

Competing interests: Author of Everything You Need to Know About the Menopause (but were too afraid to ask) (Simon and Schuster 2022)

16 June 2022
Kate A Muir
Author and documentary producer
none
London