Understanding the menopause
Tuesday, 09 August 2016
I have recently started running a menopause clinic at a local hospital which I absolutely love. Working as a GP, I am constantly seeing perimenopausal and menopausal women who are really struggling with their symptoms. Often they cannot concentrate, they are constantly tired, some of them have been inappropriately given antidepressants by other doctors to try and improve their low mood and their lives are generally miserable. They usually come to me for advice but are often very scared about the thought of taking HRT as they have read such negative press about it, despite the NICE guidance* on the menopause which was produced in November last year.
Giving HRT to menopausal women is really one of the most rewarding things I do as a doctor. To see the transformation of a woman returning to my surgery after taking HRT for three months or so is often remarkable. They tell me that their confidence has returned, their energy levels are amazing, their relationships with their partners, friends, families and work colleagues have improved and their “joie de vie” has returned.
They take HRT with a full understanding of the benefits and risks. They are all given a patient information booklet documenting these. They know that HRT has benefits in reducing their future risk of cardiovascular disease and osteoporosis. They also know that for those taking combined HRT, their risk of breast cancer is very small; it is of a similar magnitude of drinking one or two glasses of wine a night or of being overweight. Those taking oestrogen alone and those under 51 years taking HRT know that they do not have an increased risk of breast cancer. They know that any risks of HRT are reversed when they decide to stop HRT. They are also clear that they do not need to take HRT for a minimum length of time. Their dose and type of HRT has been worked out for them as an individual woman.
These women are lucky. Many women are still being given inaccurate information and are being denied HRT from their GPs. One recent survey has demonstrated results that have been echoed in previous studies. This study** showed that 61% of women perceived the menopause as a temporary phase (17% thought it lasted for one or two years and 44% thought it lasted for three to five years). In reality, more than 10% of women still have menopausal symptoms after ten years.
Around a quarter of women reported any kind of impact of the menopause on their quality of life and around 75% were experiencing symptoms. Disappointingly, 40% of those women with more than three symptoms were currently not taking any treatment at all. Of those who were not on HRT, 61% would not consider taking it (54% were 'strongly opposed' and 7% simply 'opposed'), while only 8% would consider asking their doctor for HRT.
I find these results disappointing but they reflect what I experience in clinical practice. The NICE guidance clearly state that for the majority of women under 60 years, the benefits of HRT outweigh the risks. This statement alone should give GPs more confidence to consider and prescribe HRT to women with menopausal symptoms.
Women need to be given more information about their menopause so they can then make an informed decision about taking HRT and hopefully getting on with enjoying their lives and putting menopausal symptoms behind them!
* Menopause: diagnosis and management. NICE NG23, November 2015
** Depypere H, et al. Coping with menopausal symptoms: An internet survey of Belgian postmenopausal women. Maturitas. 2016 Aug;90:24-30. doi: 10.1016/j.maturitas.2016.04.018. Epub 2016 May 7.