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Medicalising menopause can fuel 'negativity'

Thursday June 16th 2022

Menopause experts have called for a nuanced approach to treating symptoms.

Writing in today’s edition of *The BMJ*, Professor Martha Hickey, from the University of Melbourne and the Royal Women’s Hospital Victoria, Australia, says treating menopause as a hormone deficiency requiring treatment is inaccurate and fuels negative expectations that are potentially harmful.

She says while some women with severe hot flushes and night sweats often benefit from menopausal hormone therapy, others prefer not to take medication to address their symptoms.

She and her colleagues argue that social and cultural factors play a major role in women’s expectations and experiences of menopause, with societies where youth and fertility are valued equating menopause with decline.

This can result in the belief that ageing can be delayed or reversed by hormone replacement therapy (HRT) persists.

They also say medicalisation has a narrow focus on symptoms, which can mean women expect the worst and may affect how they experience menopause. After menopause, women have more positive attitudes, “suggesting that negative socially mediated expectations do not always match the reality of women’s experiences”.

However, they go on to say that most women feel unprepared for menopause: “Together with limited public discussion, poor education and shame attached to ageing in women, this leads to embarrassment and negative expectations about menopause,” they write.

The authors welcome new developments in the UK, where menopause is taught in secondary school, there are menopause policies in the workplace, and online resources to help employers support staff.

In Dr Rammya Mathew’s regular column, she discusses criticism of GPs following a television series in which TV presenter Davina McCall reported “caseloads” of women had suffered because their GPs had told them they did not need HRT.

While applauding the programme for raising awareness, she said many U-turns have been made over the safety of HRT, which have had a lasting impact on GPs’ confidence in the available evidence.

“Many of my female patients claim that I’ve given them back their sense of wellbeing after we’ve discussed the menopause and reached a joint decision about HRT,” she writes.

Hickey M, Hunter MS, Santoro N et al. Normalising menopause. *BMJ* 16 June 2022. doi: 10.1136/ bmj-2021-069369 [abstract]

Mathew R. Celebrating the quality and calibre of GPs. *BMJ* 16 June 2022; doi: 10.1136/ bmj.o1389 [abstract]

Tags: Australia | Pharmaceuticals | Women's Health & Gynaecology

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