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[Mary G]

I developed anxiety at the very early onset of the menopause.  It's very common and it often kicks in when progesterone tanks - progesterone goes west before oestrogen.  I suddenly became terrified of driving on motorways and I also became claustrophobic and scared of flying, getting into lifts and getting stuck on the tube on the way to work.  It was very real and very disabling.  Fortunately I'm completely over it now and will drive any type of vehicle anywhere plus fly and get into lifts.

My parents' neighbour suddenly developed anxiety aged 45 with no history of it and I've heard of numerous other cases plus loads of women on here of course.  It's no coincidence.

The menopause can cause a lot of damage if it goes untreated but a lot of women are in denial because they fear it and can't face it. 

When medics talk about over medicalising the menopause are they talking about fobbing women off with antidepressants or whinging about having to prescribe and manage women on HRT?

[Nas]

Seasidegirl, my understanding of over medicalising the menopause, is where the menopause is deemed to need “ treating”. Whether that be with HRT, anti depressants, or other interventions.

The notion that it can’t just be left alone, to let nature do its thing I guess.

But we know that many women seemingly sail through, whilst others struggle with debilitating symptoms.

[SundayGirl]

You asked for HRT just so you could carry on driving???

Anxiety stems from numerous causes not just hormones and can be a complex disease.

In this particular case, I think the GP was right.

Yes I did! My periods stopped and anxiety, along with bladder problems, kicked in. They were my first symptoms. I needed to drive due to where I live. Having never suffered from anxiety previously, in my case, it was purely hormonal!

Ah, more info. Apologies for assuming anxiety was your only symptom based on what you posted.
An excellent example of when medics dish out or don't prescribe correctly due to incomplete or inaccurate info. 

[Sage 🍃]

Please could someone explain what "over medicalising of menopause" actually means?  We hear this a lot and I'm not sure I understand what exactly it is supposed to mean in this  context.   

My anxiety appeared when I was peri and vanished as soon as I took HRT.   I nearly quit my job,  I'm the main breadwinner in our family, anxiety is a massive deal.    Let's not be judgemental about the symptoms of other women,  surely we're better than that.

If by ‘in this context’ you mean the editorial, let’s see what the editor says:

‘commercial companies and individuals with vested interests have over-medicalised menopause’

In my interpretation, the editor is saying that some of the benefits of MHT have been overstated by some companies and individuals, by saying that symptoms during menopause, as ’a disease of oestrogen deficiency’, are the result of falling estradiol levels and hence should be treated by ‘replacing the missing hormones’ and that menopausal women without hormonal treatment are at a higher risk of developing osteoporosis, cardiovascular diseases, depression and dementia. These are overstatements because many women don’t fall into these categories, i.e. not all women are symptomatic during menopause (clarifying that peri and menopause are very different stages), and not all women are doomed to develop diseases (very complex multifactorial conditions) without exogenous estradiol.

(For some symptomatic women and for all women who have premature menopause, as a result of surgical/chemical menopause or premature ovarian insuficiency, MHT is a medical treatment and is not considered over-medicalisation.)

The editor uses the term again ‘But over-medicalisation of menopause and promotion of MHT as a panacea is unhelpful’. Panacea is a strong word, IMHO, but if you browse the internet, some people seem to believe that hormones are going to bring back their ‘old self’.

This is the editor’s opinion. One can or cannot agree with it entirely or in part. I do agree with some of the editor’s statements but not all of them. For example, ‘Menopausal women can be strong, healthy, and happy’. I don’t think anyone can be strong, healthy and happy, independent of gender or menopause status. These sort of terms are far from scientific, including ‘safe’. Nothing is safe in life, no one is happy or healthy all of the time. Life is complex and dynamic, it can’t be defined by static idealistic concepts.

[ElkWarning]

Thanks, Sage.  Together with your comments, this is really useful.  I came to the boards today a bit upset as (after 3 years) I finally have an appt to see an NHS meno gynae later.  I feel so 'weird' because I can't, and would rather not, go back down the HRT route - it was abruptly withdrawn from me because of a sudden unexplained rise in blood pressure that wouldn't respond to treatment.  For this reason, I was taken by the line:

"But over-medicalisation of menopause and promotion of MHT as a panacea is unhelpful and only serves to divide opinions further."
^^ That's the whole line (rather than a selective quote), and it says this panacea approach has been damaging for some women - i.e. those of us who've had to try and battle against the evangelical HRT mantras.

As it goes, I also agree with the sentiments expressed in the article about gender equity in research (so calling for more unbiased / not funded by those who stand to gain research around the menopause) and similarly that, given menopause is a sex-based health condition, it should be covered under the Equality Act 2010 and adjustments made at work.  These are political statements.  In other words, the 'over-medicalisation and promotion of MHT as a panacea is unhelpful' because it robs women of the (political) protections they might otherwise enjoy during this time.  Ergo, struggles in employment are a direct result of medicalisation, i.e. it's the problem not the solution.  So disappointing for those of us without access to HRT as we're expected to suffer in silence.

With regard to the MH component, which seems so often to be classed as a symptom and only 'curable' with HRT, I was interested by the point Mary G made:
"I suddenly became terrified of driving on motorways and I also became claustrophobic and scared of flying, getting into lifts and getting stuck on the tube on the way to work.  It was very real and very disabling.  Fortunately I'm completely over it now and will drive any type of vehicle anywhere plus fly and get into lifts."
^^ I had this, but from my early 30s and (unless I had the longest peri in the world) it was nothing to do with menopause and entirely connected to trauma.  It's odd, because it's so specific, a phobia of motorways, flying and claustrophobia associated with enclosed spaces - most commonly lifts and public transport especially the tube.  After six years in weekly face-to-face therapy (minus HRT) it's mostly resolved.  In my experience, it was a combination of factors all related to a kind of 'no exit fear'.  Once again, the 'over-medicalisation and promotion of MHT as a panacea [was] unhelpful' to me because that's not what helped me, or could ever have helped me.  And yet I see women routinely dismissing mental health interventions as somehow not taking their symptoms seriously.  This is also a political issue, as it's much cheaper to get everyone on the pills than it is to meaningful talking therapies.

Finally, in relation to the above, this bit: "We need to send a realistic, balanced message to women and to society: menopause does not herald the start of a period of decay and decline but is a developmental life stage that can be negotiated successfully."  Yes, I changed career at the age of 52 and became a teacher.  Madness.  I couldn't even stay vertical for a whole day at that time, I thought I had early onset dementia (bad brain fog), struggled to walk at anything approaching a normal pace, mourning my kids leaving home, etc.  I honestly believed I was dying, both physically and emotionally, and so thought 'what the hell'.  Four years on and I'm thriving.  This isn't a message we see very often.

In conclusion, yes, we need sensible conversations and political solutions to medical problems.

[CrispyChick]

So how did you go from 'feeling like dying' elkwarning to 'thriving'? In 4 years?

Did you wait it out and it got better?
Did you take alternative treatments?
Was this the time you were on Hrt?
Or was this when you were treated for autoimmune stuff (as mentioned in other threads)?

This is the problem for me. How do you 'get better' when feeling like you are dying on a daily basis?

It's also strange that many in this thread are calling this so called 'medicalisation' and so called panacea for HRT - when, across this forum, woman are complaining time and time again of being ignored by their GPs and their symptoms belittled.

And, I'll probably get in trouble again for not reading the article. But quite frankly, feeling as bad as I do at this stage in my life, words dont help me.

[Penguin]

Thanks, Sage.  Together with your comments, this is really useful.  I came to the boards today a bit upset as (after 3 years) I finally have an appt to see an NHS meno gynae later.  I feel so 'weird' because I can't, and would rather not, go back down the HRT route - it was abruptly withdrawn from me because of a sudden unexplained rise in blood pressure that wouldn't respond to treatment.  For this reason, I was taken by the line:

"But over-medicalisation of menopause and promotion of MHT as a panacea is unhelpful and only serves to divide opinions further."
^^ That's the whole line (rather than a selective quote), and it says this panacea approach has been damaging for some women - i.e. those of us who've had to try and battle against the evangelical HRT mantras.

As it goes, I also agree with the sentiments expressed in the article about gender equity in research (so calling for more unbiased / not funded by those who stand to gain research around the menopause) and similarly that, given menopause is a sex-based health condition, it should be covered under the Equality Act 2010 and adjustments made at work.  These are political statements.  In other words, the 'over-medicalisation and promotion of MHT as a panacea is unhelpful' because it robs women of the (political) protections they might otherwise enjoy during this time.  Ergo, struggles in employment are a direct result of medicalisation, i.e. it's the problem not the solution.  So disappointing for those of us without access to HRT as we're expected to suffer in silence.

With regard to the MH component, which seems so often to be classed as a symptom and only 'curable' with HRT, I was interested by the point Mary G made:
"I suddenly became terrified of driving on motorways and I also became claustrophobic and scared of flying, getting into lifts and getting stuck on the tube on the way to work.  It was very real and very disabling.  Fortunately I'm completely over it now and will drive any type of vehicle anywhere plus fly and get into lifts."
^^ I had this, but from my early 30s and (unless I had the longest peri in the world) it was nothing to do with menopause and entirely connected to trauma.  It's odd, because it's so specific, a phobia of motorways, flying and claustrophobia associated with enclosed spaces - most commonly lifts and public transport especially the tube.  After six years in weekly face-to-face therapy (minus HRT) it's mostly resolved.  In my experience, it was a combination of factors all related to a kind of 'no exit fear'.  Once again, the 'over-medicalisation and promotion of MHT as a panacea [was] unhelpful' to me because that's not what helped me, or could ever have helped me.  And yet I see women routinely dismissing mental health interventions as somehow not taking their symptoms seriously.  This is also a political issue, as it's much cheaper to get everyone on the pills than it is to meaningful talking therapies.

Finally, in relation to the above, this bit: "We need to send a realistic, balanced message to women and to society: menopause does not herald the start of a period of decay and decline but is a developmental life stage that can be negotiated successfully."  Yes, I changed career at the age of 52 and became a teacher.  Madness.  I couldn't even stay vertical for a whole day at that time, I thought I had early onset dementia (bad brain fog), struggled to walk at anything approaching a normal pace, mourning my kids leaving home, etc.  I honestly believed I was dying, both physically and emotionally, and so thought 'what the hell'.  Four years on and I'm thriving.  This isn't a message we see very often.

In conclusion, yes, we need sensible conversations and political solutions to medical problems.

Your fourth paragraph really resonates with me. Travelling to Australia post lockdown with husband and two young children, less than a year after losing my mum, I had a massive mental health deterioration. The GP there pushed and pushed me to take hrt, saying it was peri fluctuations making me so terrified of everything. I tried and failed with two pumps of gel, and ended up in a worse state than before. It was only getting back to the UK, 14 months of worse and worse anxiety and everyone telling me it was just hormonal and natural (and a number of clinicians telling me to up the estrogel)  that I ended up seeing a private psychiatrist who got me on the correct medication (and a toolkit of ad hoc for when needed) and properly sorted out a diagnosis of complex ptsd and ocd triggered by trauma, that I started getting better. I stopped hrt in April, started with the psychiatrist the same month and am still off hrt and doing so much better. Still in peri but hrt was not the right answer for me as I was having too many fluctuations. I still have blips at the end of my (still fluctuating) cycle, but they now last 1-2 days rather than being in a black hole for most of the time. I do think hormones play a part but hrt isn't the only answer and I think women need to be empowered to make informed choices about what route to take. I also think this needs to be enshrined in law with menopause a protected characteristic.

[Penguin]

So how did you go from 'feeling like dying' elkwarning to 'thriving'? In 4 years?

Did you wait it out and it got better?
Did you take alternative treatments?
Was this the time you were on Hrt?
Or was this when you were treated for autoimmune stuff (as mentioned in other threads)?

This is the problem for me. How do you 'get better' when feeling like you are dying on a daily basis?

It's also strange that many in this thread are calling this so called 'medicalisation' and so called panacea for HRT - when, across this forum, woman are complaining time and time again of being ignored by their GPs and their symptoms belittled.

And, I'll probably get in trouble again for not reading the article. But quite frankly, feeling as bad as I do at this stage in my life, words dont help me.

I'd be interested to know what helped too. But also think that nobody really looks further than 'oh its meno, you need estrogen' in terms of helping with such symptoms. Either that or bog standard anti depressants without any real thought to a diagnosis and tailored treatment plan. It's only if you can go private and pay for things like additional testing (non conventional stuff) that you can get really tailored help. It's a shame this isn't available on the NHS and the only two options are hrt or ssri meds.

[bombsh3ll]

Please could someone explain what "over medicalising of menopause" actually means?  We hear this a lot and I'm not sure I understand what exactly it is supposed to mean in this  context.   

They mean treating it like a medical condition or disease ie prescribing replacement for the lost hormones as with diabetes or hypothyroidism, rather than a natural process that doesn't require treatment. The same debate is sometimes held around pregnancy and birth. Unfortunately in both cases it is women who pay a high price when nature is left to take its often cruel course.

My personal view is that whilst menopause is universal if women live long enough, it is a pathological state with a multitude of undesirable health consequences. I know others hold different views and that's fine.

If anyone lives long enough, similar to a car or other appliance, some part or other will pack in eventually, and I personally choose to get it replaced rather than limp along without it.

I would much rather take replacement sex hormones than treat each menopausal symptom or consequence separately, with osteoporosis medication, sleeping pills, antidepressants, beta blockers for palpitations, oxybutinin for incontinence, multiple courses of antibiotics for UTIs, statins for high cholesterol etc.

That's the real overmedicalisation in my view.

[Nas]

bombsh3ll Genuine question

What would you do, IF you could not take the hormones you needed to treat your symptoms?

So in my case, I have metastic BC ( hormone fed). If you developed something like this, where hormone therapy was dangerous and you were on hormone blockers, what approach would take?

I ask because short of taking all those medications you have listed, I feel entirely stuck.

[bombsh3ll]

I'm so sorry you're in that situation Nas, and other women who find themselves there too.

I was only speaking about my own personal approach and not suggesting what others whose medical history, goals or values may differ from mine should do.

Your question is something I have given a lot of thought over the years as a non carrier within a BRCA family.

I am in the extremely privileged position of having been able to get risk reducing mastectomies at 29, and when genetic testing later became available I learned I was negative for the gene, but if it did happen to me, first off I would explore the possibility of taking tamoxifen as my "estrogen" as it is a SERM with some estrogenic activity especially on bone and heart health, even if it were not my oncologist's first choice.

If that wasn't possible, then depending on my symptoms and prognosis, I would probably be in the camp who would prioritise quality of life above length of life. I would of course consider what was the lowest risk option, be that bazedoxifene (would seek abroad if necessary) raloxifene or tibolone. Even CEE has been postulated to have SERM like activity on the breast so that might be on there too.

Of course this is a very personal choice and I am not for one moment suggesting it is right for everyone, or even that I wouldn't change my mind if I were actually faced with that, but I do believe people should have the autonomy to choose quality of life over potential length of life where estrogen (or any other medical treatment) is concerned.

Absolutely I am glad that other symptomatic treatments exist for those who can't or choose not to take hormones, however I am concerned that many women without contraindications are needlessly scared of estrogen and instead end up on less beneficial treatment.

[Nas]

Many thanks for your honest and detailed reply bomb.

My brain is rapidly steering towards quality over quantity of life now and this is indeed the conversation that I will be having with my oncologist tomorrow.

Let’s say your cancer was contained to one area in the first instance and was responding well to treatment. But quality of life has been shot to bits ( surgical menopause coupled with AI). How would you respond to medics who just can’t and won’t endorse any hormonal ( or hormonal type ) treatment at all. In other words you are banging your head against a brick wall.

Feel free not to answer because I am thinking aloud, but have no way of discussing this without being shut down by the medics.

[Seasidegirl]

NAS, I'm really sorry for the position you find yourself in.

I had DCIS agreed 46 7 years ago.   Found early on family history screening as my mum died aged 46 of BC.

I had a first mastectomy as the DCIS was too extensive to get with the three wide local excisions that they tried.

I then had a second risk reducing mastectomy on the other side as the pathology of the first side indicated greater risk in the second.  I am BRCA/BRCA2 non carrier.   

I stayed away from HRT after i became peri in 2016 until this year when I just couldn't cope any longer and I made the decision to prioritise quality of life.   

It's a different decision to yours and I'm grateful that my mastectomies mean that my BC risk is likely lowered.   They're is so little evidence though and that makes everything so much more difficult 

[Nas]

Thanks Seasidegirl,
If there was ever a moral dilemma, it is this. Trapped between a rock and a hard place!

I am sorry to hear of your mum. Sadly this disease is still taking far too many women and  although treatments are plentiful, they remain brutal.

I too had the mastectomy ( and the chemo ) but it returned.

As you rightly say, evidence is in short supply and we are left having to make tough decisions.

I will mull it over with oncology. But we know that their role is to aim to preserve life.

Thanks again.

[bombsh3ll]

Many thanks for your honest and detailed reply bomb.

My brain is rapidly steering towards quality over quantity of life now and this is indeed the conversation that I will be having with my oncologist tomorrow.

Let’s say your cancer was contained to one area in the first instance and was responding well to treatment. But quality of life has been shot to bits ( surgical menopause coupled with AI). How would you respond to medics who just can’t and won’t endorse any hormonal ( or hormonal type ) treatment at all. In other words you are banging your head against a brick wall.

Feel free not to answer because I am thinking aloud, but have no way of discussing this without being shut down by the medics.

My heart goes out to you.

I think there is a real imbalance of power within healthcare, and I do not think one person (or even a MDT) should be in a position of such power to be able to condemn another human being to a life of misery and suffering.

Living is about more than just not being dead (a conversation that I have had with my cardiologist who was reluctant to put a pacemaker into me on the grounds that I wasn't dead without it - I sure as hell wasn't living with a heart rate of 42!)

The evidence that taking estrogen even makes a significant difference to the risk of breast cancer progression or recurrence is sketchy at best - some studies indicate yes, others no. Estradiol has also historically been used to TREAT breast cancer.

If I were in your shoes, I would firstly try to seek out a provider who has publicly advocated for women to be given autonomy in terms of estrogen/breast cancer.

Louise Newson is one of them, there is also Dr Tina peers, a UK menopause doctor who has had breast cancer twice and takes HRT herself. She has a couple of videos on YouTube if you are interested.

Failing that though, if I had made an informed decision to take hormone therapy and couldn't get it honestly, I'd go somewhere else that didn't have my medical records, abroad if necessary, and not disclose the cancer.

I'm not suggesting this is what you should do, but it's what I'd do. I'd do whatever I needed to - ask a friend or relative to buy it in their name etc. and I wouldn't feel guilty, because I'd regard the quality of my remaining life as paramount.