2024/03/07
dpa
Managing menopause symptoms is important, and yet experts say a medicalized view of this process can be disempowering for women.
Christin Klose/dpa
The menopause is not a disease, despite much discourse in Western countries leading women to think otherwise, a group of experts have said in a paper in The Lancet that argues that this period in life is being "over-medicalized."
High-income countries commonly see menopause as a medical problem or hormone-deficiency disorder with long-term health risks “that are best managed by hormone replacement (therapy)”, they said.
Yet, around the world, “most women navigate menopause without the need for medical treatments”, the experts, including from the Royal Women’s Hospital in Melbourne, Australia, and King’s College London, said.
They argued there is a lack of data on whether health problems are caused by menopause or simply by ageing.
For example, although bone density is known to decline after menopause, “whether menopause at the average age increases other chronic conditions such as diabetes, dementia, or cardiovascular disease is uncertain”, they said.
“Although management of symptoms is important, a medicalized view of menopause can be disempowering for women, leading to over-treatment and overlooking potential positive effects, such as better mental health with age and freedom from menstruation, menstrual disorders, and contraception,” the scientists wrote.
The team said that how women feel when going through the menopause can be difficult to differentiate from other things happening in their lives, such as caring for children, working, and looking after elderly parents.
Issues that are sometimes put down to the menopause – such as changes in mood, brain function and sexual problems – could actually be caused or made worse by these stressful life events, they said.
Instead, they argued for a “new approach” to the menopause based on “health empowerment”, where women are given the knowledge, “confidence and self-determination to self-manage their health” and make informed decisions.
They suggest there are other methods for dealing with symptoms such as hot flushes, including cognitive behaviour therapy (CBT) and hypnosis, arguing that CBT has been shown to have a small to moderate effect on cutting hot flushes, night sweats, sleep disturbance, depression, anxiety and fatigue.
Medics should also look at women’s lifestyles, such as sleep, alcohol intake and smoking, which can make symptoms worse.
While hormone replacement therapy (HRT) has been shown to improve sleep, memory, and concentration in women taking it for hot flushes, it is “unlikely to have any effect in women without” flushes, they said.
And while it cuts the risk of bone fractures, evidence shows these benefits can dwindle five years after HRT is stopped.
If women do want HRT, the experts said medics should provide “realistic information about the likely effects of treatment, the potential for residual symptoms, and the possibility that symptoms could recur when treatment stops”.
A second paper in The Lancet Series found no evidence of an increased risk of mental health disorders for women going through the menopause.
“On the basis of scarce data, we found no compelling evidence that risk of anxiety, bipolar disorder, or psychosis is universally elevated over the menopause transition,” the team said.
Series co-author Professor Martha Hickey, from the University of Melbourne and Royal Women’s Hospital, said: “The misconception of menopause as always being a medical issue which consistently heralds a decline in physical and mental health should be challenged across the whole of society.
“Many women live rewarding lives during and after menopause, contributing to work, family life and the wider society.
“Changing the narrative to view menopause as part of healthy ageing may better empower women to navigate this life stage and reduce fear and trepidation amongst those who have yet to experience it.”
The menopause is not a disease, despite much discourse in Western countries leading women to think otherwise, a group of experts have said in a paper in The Lancet that argues that this period in life is being "over-medicalized."
High-income countries commonly see menopause as a medical problem or hormone-deficiency disorder with long-term health risks “that are best managed by hormone replacement (therapy)”, they said.
Yet, around the world, “most women navigate menopause without the need for medical treatments”, the experts, including from the Royal Women’s Hospital in Melbourne, Australia, and King’s College London, said.
They argued there is a lack of data on whether health problems are caused by menopause or simply by ageing.
For example, although bone density is known to decline after menopause, “whether menopause at the average age increases other chronic conditions such as diabetes, dementia, or cardiovascular disease is uncertain”, they said.
“Although management of symptoms is important, a medicalized view of menopause can be disempowering for women, leading to over-treatment and overlooking potential positive effects, such as better mental health with age and freedom from menstruation, menstrual disorders, and contraception,” the scientists wrote.
The team said that how women feel when going through the menopause can be difficult to differentiate from other things happening in their lives, such as caring for children, working, and looking after elderly parents.
Issues that are sometimes put down to the menopause – such as changes in mood, brain function and sexual problems – could actually be caused or made worse by these stressful life events, they said.
Instead, they argued for a “new approach” to the menopause based on “health empowerment”, where women are given the knowledge, “confidence and self-determination to self-manage their health” and make informed decisions.
They suggest there are other methods for dealing with symptoms such as hot flushes, including cognitive behaviour therapy (CBT) and hypnosis, arguing that CBT has been shown to have a small to moderate effect on cutting hot flushes, night sweats, sleep disturbance, depression, anxiety and fatigue.
Medics should also look at women’s lifestyles, such as sleep, alcohol intake and smoking, which can make symptoms worse.
While hormone replacement therapy (HRT) has been shown to improve sleep, memory, and concentration in women taking it for hot flushes, it is “unlikely to have any effect in women without” flushes, they said.
And while it cuts the risk of bone fractures, evidence shows these benefits can dwindle five years after HRT is stopped.
If women do want HRT, the experts said medics should provide “realistic information about the likely effects of treatment, the potential for residual symptoms, and the possibility that symptoms could recur when treatment stops”.
A second paper in The Lancet Series found no evidence of an increased risk of mental health disorders for women going through the menopause.
“On the basis of scarce data, we found no compelling evidence that risk of anxiety, bipolar disorder, or psychosis is universally elevated over the menopause transition,” the team said.
Series co-author Professor Martha Hickey, from the University of Melbourne and Royal Women’s Hospital, said: “The misconception of menopause as always being a medical issue which consistently heralds a decline in physical and mental health should be challenged across the whole of society.
“Many women live rewarding lives during and after menopause, contributing to work, family life and the wider society.
“Changing the narrative to view menopause as part of healthy ageing may better empower women to navigate this life stage and reduce fear and trepidation amongst those who have yet to experience it.”
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