Menopause: over-medicalised & over-monetised?

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The menopause pendulum has perhaps swung too far in the opposite end of the spectrum; from menopause shampoo to menopause cake, it’s currently not easy to make it through a day without sight or sound of the ‘M word’ in print, on podcasts, social media and TV. And what an epic Trojan horse the topic of menopause has become in the media. The celebrity arena has certainly pursued it and put it on the map. Whilst this is something to be recognised as supportive for all – the other side of the coin is that we are now fed how our menopause should be from a glass slipper. Poverty is not offered a place at the ‘doing menopause well’ table!

Make no mistake though, menopause is big business and, as a sector, it occupies quite a fortunate position, in that it is almost guaranteed a potentially endless supply of consumers looking for the next fix, pill, patch (or shampoo/cake). Yet HRT shortages rumble on, and accessing testosterone, in the UK at least, remains challenging, if not totally impossible for many.

Fierce debate recently took hold on social media over the use of the word ‘deficiency’ in relation to menopause. In many respects, it makes perfect sense, and as post-menopausal women, we are technically deficient in oestrogen. That is an undeniable fact for both of us. However, whilst folk argue over semantics and stifle open debate, are we losing sight of the purpose of grassroots awareness-raising campaigns and social activism? What motivational factors sit at the centre of decision-making, and are we seeing ego- and eminence-driven opinion as opposed to evidence-based facts, policies and guidelines? Have we smashed patriarchy or simply replaced one oppressive force with another?

And what of trauma-informed healthcare? Many victims of sex and gender-based violence avoid routine cervical smear tests and gynaecological examinations through very real fears of re-traumatisation. Moreover, the unpredictability of peri/menopausal symptoms can and does reflect the childhood experience of sexual abuse “peri-menopause made me feel out of control, and that was triggering for me” (de Vos & Douglas, 2022).

It’s easy to be swayed by headlines; the rise in suicide rates amongst women in the 45-54 age bracket, higher rates of divorce, depression, anxiety, paranoia and rage. Women are leaving their careers we are told, and yet is menopause really the primary driver or the final straw in that decision-making process? According to the NICE guidelines, HRT and not anti-depressants should be the first-line treatment for low mood due to menopause. Similarly, CBT can also be useful in helping women to better manage insomnia, hot flushes and night sweats associated with the hormonal transition.

Yet, countless women are still prescribed anti-depressants as a first-line treatment for low mood and depression during mid-life. Without access to a private consultation at a menopause clinic to provide swift and comprehensive hormonal healthcare, it’s difficult to see how in the short term, anything will change. NHS menopause clinics are woefully thin on the ground.

Yet, we really do have a golden opportunity to improve the peri/menopause landscape for those who follow behind us. Writing on the need to seize this opportunity to co-produce truly holistic hormonal healthcare, by empowering patients and clinicians alike, Dr Gayathri Delanerolle writes “we have an opportunity to prevent menopause transforming from a ‘silent’ to a ‘living’ epidemic”. How very true.

If you would like to join the conversation to help improve both understanding and access to the coproduction needed for women in peri/menopause please sign up for our upcoming workshop ‘Menopause Madness! Challenging the mass pathologizing of the menopause’ with AD4E on the 22nd May 2024.

 

 

References: de Vos, A. & Douglas, H. (2022) Online Inquiry: CSA survivors awareness of menopause. White Paper, p. 4-6. Dignified Menopause Global Initiative.

 

2 COMMENTS

  1. Thank you very much to both Aneesh and Retired Physician.

    As a Midwife, I find the prescribing of anti-depressants and Cognitive Behavioural Therapy for Menopause absolutely ludicrous. I would never refer a person with a broken leg to a Rheumatologist. This falls under both remits of Endocrinology and Gynaecology. I strongly feel that women are being unheard, suffering and the attitude is simply get on with it. Medicine has advanced in many areas. However, it appears that in certain fields, we are reverting back to The Lunacy Act (1845) where women were institutionalised due to ‘hysteria’.

    I am fully aware of the Gender Inequalities in Health Care. Baroness Julia Cumberledge has produced some extensive and well written reports. In one of the reports which was published in 2020, and entitled First Do No Harm, 700 women, their partners and children were LISTENED to. They had suffered significant and avoidable harm as a direct consequence of 2 medications and 1 medical device. Many were left physically disabled and the whole family unit suffered as a result. Outcomes were poor.

    The first theme and overarching theme to this particular Report is – No-one is listening – the patient voice dismissed. It furthered by discussing how women not being believed, the clinicians’ dismissive and unhelpful attitudes and the sense of abandonment. It also hi-lights the systemic failings and more practitioners like Dr Gayathri Delanerolle, Specialist in Reproductive Health, need to speak out. As I do.

    Retired Physician has very rightly pointed out that these Prescription Errors can cause Adverse Side effects. These include on a physiological level, genital numbing, vaginal dryness, lack of libido and AKATHISIA. On a cognitive level, disinhibition and emotional blunting. So, are we committed into making women physically sicker and into zombies ? To the point of job loss and unable to fulfil their Societal Roles. Women are the main care givers. They care for elderly relatives, partners, children and grandchildren. I believe in a nutshell it is Consumerism. It is a buyer’s market.

    Menopause is a hot topic with The British Menopause Society reporting on 28 November 2023 which HRT medications are available. However, what is the cost to a GP Practice in prescribing HRT as opposed to antidepressants ? Drug companies do offer incentives to individuals and Trusts. I am pretty certain plenty of Back Handers occur. Please note that a family member is a Drug Representative and a couple of decades ago, whilst working on a General Ward I socialised with the doctors. We would be treated to meals out and the like by our frequently visiting Drug Representative.

  2. “Yet countless women are still prescribed anti-depressants as a first line treatment for low mood and depression during midlife”.

    If this suffering is a manifestation of peri/menopausal morbidity, surely it is beyond counterintuitive to give powerful anti-libidinous drugs such as SSRIs?
    Are these women informed that they are they are now vulnerable to drug-induced sexual dysfunction where the primary clinically distinguishing feature is genital numbing?

    If the woman has the courage to report this to her prescriber, perhaps the two most likely ‘explanations’ she may be given are:
    ‘It’s the depression’; or ‘this could be peri/menopausal’.
    The former is likely to result in an increased dose of antidepressant, and hence increased risk of AKATHISIA, disinhibition and emotional blunting with risk of harm to self or others.

    Whilst the management of SSRI induced genital numbing, vaginal dryness, inability to reach/or pleasureless orgasm, (or complete loss of interest in all aspects of sexuality) would necessitate ‘de-prescribing’ the antidepressant, PSSD (Post SSRI Sexual Dysfunction) is reported to last (in some cases) for months, years and perhaps indefinitely.
    Withdrawal of the antidepressant may not be possible in those individuals who are vulnerable to intolerable antidepressant withdrawal syndromes.

    Are these ‘countless women prescribed antidepressants as a first line treatment for low mood and depression in mid life’ afforded fair, full and informed consent?