Managing the menopause – a second opinion

Why is it that so many women going through the menopause remain so badly neglected by the medical profession and society as a whole?
Every woman can expect to experience the menopause one day, and most will spend more than one-third of their entire life in the postmenopause period.
So why do we allow so many thousands of women, who are unfortunate to have moderate or severe symptoms at this time, to suffer so needlessly?
Why does society still tend to write women off after their reproductive years, believing that the change of life is something that women simply have to grin and bear?
An individual experience
Every individual woman's experience of the menopause will be unique and different, but a significant number still suffer terribly.
I have known many strong, capable female patients over the years who have been devastated by the effects of a bad menopause. Some have not even recognised the underlying problem.
Many are poleaxed by distressing physical symptoms such as hot flushes, night sweats and weight gain. Others are driven to distraction by common psychological problems such as depression , anxiety , insomnia and mood swings.
But why do we allow this to happen when treatments can be so effective? Why are more enlightened attitudes and alternative ways of looking at the menopause, which ushers in the next natural stage in any woman's personal development, not yet more prevalent?
The menopause can be a calmer stage of a woman's life, a time when she is free of the responsibilities of child bearing and child rearing, a period when she finally has time to concentrate on herself and on the creativity and independence that this freedom brings.
Society's attitude
Attitudes within society are important determinants of how women see themselves and how they should react to the menopause.
It's easy to see how this natural change in a woman's life has become overly medicalised, just as childbirth and eating disorders (a particularly feminist issue) have become medicalised.
It is appalling that so many postmenopausal women are regarded as sexually and socially obsolete and medically and emotionally out of control.
Treatment options
There are now many beneficial ways of solving difficulties when and if they arise, and the future for women experiencing the menopause is very bright.
So whether women rely on simple self-help measures, natural oestrogens in their diet, a variety of complementary medicines or the latest hormone replacement therapy, their 'change' as it is commonly called, can become a change for the better.
Issues to bear in mind
Many women take hormone replacement therapy (HRT) for the immediate physical symptoms of the menopause, only to discontinue treatment when perhaps they most need it.
But how many women know about all the different
formulations of HRT ? Or have been scared by reports in the media about the side-effects?
How many doctors are currently prescribing inappropriate types of HRT to women, or subjecting them to ridiculously high levels of oestrogen through the over-frequent use of hormone implants without bothering to check blood levels first?
Where is all the sensible and balanced guidance about complementary therapy as an alternative to HRT for the menopause?
It is estimated that one in five postmenopausal women take HRT. Yet one in four postmenopausal GPs take it. So if they know something their fellow female patients don't, maybe they should try harder to pass the information on.
Long-term risks of HRT
HRT is not the best thing since sliced bread, but it could benefit a large number of women who are currently not offered it.
Long-term use of HRT slightly increases the risk of breast cancer , endometrial cancer, heart disease , blood clots and
stroke.
This means a GP will discuss the evidence regarding the risks and benefits of HRT with each woman before any decision is made to start treatment.
HRT and osteoporosis
HRT can protect against osteoporosis . But because of the above risks it is no longer recommended for postmenopausal women over the age of 50 unless other treatments for osteoporosis have been tried and not tolerated, or aren't suitable.
HRT should not be considered first-line treatment of osteoporosis in women over the age of 50.
It is of most benefit for the prevention of postmenopausal osteoporosis if started early in the menopause and continued for up to 5 years but bone loss starts again on stopping HRT.
Based on a text by Dr Hilary Jones,

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