This week I have given a talk to my Masters students on the concepts and controversies module. My talk was about menopause. It was straightforward to explain the concepts: what the menopause is, symptoms, diagnosis, treatments. But the more I thought about it, my list of controversies got longer and long.
In this blog, I thought I should explain what I think are some of the controversies are around the menopause. I am sure you can think of more – let me know.
Lack of education
My research and others have shown that very few people have had any formal education of the menopause. This is unacceptable. In 2019, the UK Department for Education said we have to teach menopause at schools, and the International Fertility Education Initiative has produced a free teaching guide and PowerPoint for teachers which includes menopause education (it is available now on request to me and will soon be on www.eshre.eu/IFEI) but we have a long way to go.
My research shows that since many women in their 40s do not know about menopause symptoms, they may experience symptoms without understanding what is happening. Added to this is the lack of education of many health professionals, such that women can be turned away as they are told ‘they are too young’.
Lack of research into different ethnicities and transmen
I have done three surveys about the menopause and most participants are highly educated white women. I launched a survey specifically for Black women which you can access here, but we have had a very low uptake. It is essential to hear everyone’s voices, to know how they feel about menopause and how we can help them.
A hugely unresearched area is transmen, some of whom will enter menopause at a young age, and quite suddenly. We have to open the conversations with transmen to best know how to support them through this.
Negative narrative
In the UK, we have created a very negative narrative of the menopause, which is unfair to women of all ages. This creates fear and stigma. We have a society that likes to hear bad news, and those reporting positive menopause experiences are often shot down. I heard someone on social media suggesting that those reporting their positive menopause experiences were medically gaslighting. We need to get this in perspective, listening to everyone’s journey, and letting women know that for many, life post menopause is one of the best times of their lives.
Lack of support with symptoms
In my research so many women reported a lack of support with their symptoms, from their doctor, workplace, family and friends. And to add to this, last week the UK decided not to consent to menopause leave. Surely if a woman is flooding or has a crippling migraine, she should be allowed time off work? Some women will hide what they are going through as they worry about being stigmatised. There is a worry that presenting menopause symptoms in the workplace will penalise women in their 40s and 50s. We have to acknowledge that women have symptoms that can affect their daily wellbeing and give women support at work and home. I have made a YouTube video about menopause symptoms.
We are individual
Every woman’s experience of the menopause will be different. This is a key point I make when I go into companies. It is terrific to talk about it and give each other support, but some feel that everyone should be experiencing the same symptoms. If they are having a difficult time, everyone else should and vice versa. Our menopause experience depends on so many variables, such as genetics, weight, fitness levels, sleep, nutrition, other health conditions and much more. We need to treat every woman as an individual; not penalising those that have symptoms or those who do not.
Often portrayed as an illness
This is more common in the UK than other countries, but there are many of us who do not feel that the menopause is an illness. I feel that suggesting this is disease mongering – you can hear my talk on YouTube. It is a transient stage that women go through, which can be difficult due to fluctuating hormones. But once we are post menopause and the hormones have levelled off, many women will find themselves in a new place. Personally, I feel that the sex hormones are very powerful and during our fertile years, women may experience highs and lows caused by these hormones. Premenstrual syndrome (PMS) is common and is a result of changing hormone levels. Post menopause, there is no more PMS and no more periods. Which are two things to be embraced. I am part of the growing group of people who feel that life without hormones can be amazing.
HRT is not a preventative medicine
This is also a UK phenomenon. I have spoken to many women and health professionals in other countries, and they have not heard about this. HRT can reduce the risk of osteoporosis and heart disease, but for those with no medical history of these diseases, there are other ways to reduce the risk. Some also claim it can reduce the risk of dementia, but a group of us do not agree and we are writing a paper about the research.
Difficulties obtaining HRT
All women who have symptoms that are affecting their wellbeing and can be improved by taking HRT, should certainly be prescribed it and I think most GPs are doing this now. But there has been a HRT shortage in the UK and there are several reasons for this, such as COVID, but I think some of this has arisen as more women feel they should take HRT, even when they have no symptoms. We now have a much higher rate of HRT use than other countries.
Compounded bioidentical hormones
These are unregulated hormones that are often marketed as being individual and natural. But they are not licensed by the Medicines and Healthcare products Regulatory Agency who regulates medicines, and they are not recommended by the British Menopause Society.
Ovarian tissue freezing
There are some companies who suggest women in their early 30s should freeze their ovarian tissue which can then be transplanted back when they are perimenopausal so that the menopause can be delayed. This tissue would be able to release oestrogen and progesterone. Many people do not recommend this procedure for many reasons.
Portrayal of menopausal women in the media
I have three comments on this. First we see menopausal celebrities with bodies which are unrealistic to the majority of menopausal women. I do not want to body shame, but I also do not want women to think that this is how they should be looking. I wrote an article about this in the Mail on Sunday. Most of us never had a six pack in our 20s so we are unlikely to get one in our 50s! And being super lean is not necessarily healthy or sustainable.
The second point is that we only seem to want to hear negative menopause stories in the media as I said above.
The final point is how we portray older women in the media, which I think has really improved. We are seeing more older models and leading roles for women of all ages. Let’s hope this continues.
Big money
The good news is that everyone is talking about menopause. The bad news is that it opens the doors to companies who want to make money out of menopausal women. I am not convinced we need special menopause clothes – surely no clothes should be making us sweat? Or special pills, potions, lotions, or facials for our vagina.
I would love to hear your views. There are other topics you may feel are a controversy of the menopause. Please let me know.
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