Is menopause a deficiency state or a natural stage of life?
In recent years, the discourse surrounding menopause has shifted significantly, from welcome moves to bring the experience out into the open and challenge the stigma, to rebound claims of over-medicalisation. Despite being a natural biological transition, menopause now faces the risk of being a disease, a hormone “deficiency” state. That’s about as accurate as describing prepuberty as a hormone deficiency state (the hormone levels during puberty are similar to menopause). Endocrine organs with true deficiency states include the thyroid and pancreas – when they stop functioning, body processes progressively fall apart and do not rebalance (which is what happens after our ovaries cease working after menopause).
Describing menopause as a disease implies women are inherently faulty and this can be disempowering.
Menopause, in its essence, marks the cessation of menstruation and the end of reproductive capacity. It is a normal phase of life that every woman experiences, typically occurring in her late 40s to early 50s. However, recent claims highlight societal attitudes and the medical industry’s focus on treating menopause as a condition to be cured rather than a natural transition have led to an abundance of medical interventions – supplements, special diet protocols, wellness programs, fancy celebrity face sprays as well as hormone replacement therapy (HRT) and other pharmaceutical treatments.
This is no way dismisses the fact that 25% of women will experience a very bothersome time through perimenopause and menopause and a further 50% will suffer mildly. There are effective hormonal treatments for flushes, sleep disorders, mood changes and protecting bone health and women should have access to them provided they are safe for them personally.
Menopause is natural but suffering need not be!
There is no doubt there is a misrepresentation of menopause in mainstream media leaving an unbalanced view of the menopause experience.
The impact and frequency of symptoms are often overstated.
This is due to the nature of surveys (if you poll a FB menopause group, you will get the impression 95% of women are at wit’s end due to menopause). This is called “convenience ” sampling. When you survey a true random cross-section of women, around 25% of women have severe symptoms and around the same number have very few. The women with few symptom are not heard from. There is no problem with this type of survey data provided it is recognised for its bias.
Workplace disruption may have been overestimated.
Results of a frequently quoted UK study, revealed ‘nearly one million’ women quit their jobs in the UK. However, a critical analysis of that statistic revealed it came from a poorly designed survey that included a variety of reasons (including pregnancy) for why women left the work force, and then wrongly claimed the entire leave burden was due to menopause alone.
Hyper-vigilance of symptoms.
When the ’34 symptoms’ have been expanded to a list scores long, many of which are quite non-specific (who doesn’t have wrinkles over 50?!), it’s no wonder we are all complaining of the burden of menopause. Many symptoms have multiple contributing factors – low sexual desire among the top of this list. Drawing frequent attention to possible symptoms actually makes it more likely they will be experienced. Think of itch….or yawn…
Expectations that the symptom burden can be removed using hormones have skyrocketed.
Hormone treatments are the best solution for women with flushes, sweats, sleep disturbance and vaginal dryness when periods are starting to skip. They work less well for many of the other symptoms attributed to hormones or when periods are still regular. Testosterone has even less evidence of effectiveness and yet it is having a moment of popularity.
Ignoring life choices and behaviours in the belief the MHT will provide protection is a danger. MHT can be simply one facet of good health, depending on your personal circumstance. Its protective effects on the heart and brain are estimated to be similar to those offered by avoiding obesity, or not drinking 2 glasses of alcohol a day. Menopause provides the time stamp to check in with your health and how you look after it.
The Australian Menopause Society has been at the forefront of relabelling “hormone replacement therapy” (HRT) as “menopause hormone therapy” (MHT). Why? Because using these hormones is a treatment and can in no way “replace” the sophisticated balance of hormone levels and feedback systems that occur throughout the natural menstrual cycle. It’s good, but it’s not that good!
The Lancet Series offers an “empowerment model for managing menopause”, emphasising the importance of carefully weighing the risks and benefits of HRT and empowering women to take action across their life – a time to focus on healthy habits. It has provoked a strong reaction! Let’s not be swept up in a polarising argument of women “simply being dismissed” but reflect on the important viewpoint offered in these articles.
Moreover, the Jean Hailes Foundation’s National Women’s Health Survey underscores the need for a more holistic approach to menopause management. Rather than relying solely on pharmaceutical interventions, the focus should be on promoting overall health and well-being during this transition. Lifestyle modifications, including regular exercise, a balanced diet, and stress management techniques, can play a crucial role in alleviating menopausal symptoms and improving quality of life as well as optimising longterm health. It also presents a snapshot of accurate data on the true impact of menopause on a random cross section of Australian women – they found only 7% of midlife women bothered by symptoms missed work due to those symptoms.
Many women choose to use MHT for the symptom relief and the health benefits it offers. It is their right to be correctly informed, well advised and receive personalised care, which may or may not include MHT. Women should not feel that they are neglecting their health if they don’t chose to use MRT, and they are not “deficient” because they have passed through menopause. They are simply transiting to a new stage of life and will emerge stronger and more assured without the burden of pregnancy and periods!
Key Take Aways
Menopause is not a “deficiency” state, is a natural life stage.
Women have the right to accurate, personalised advice and make their own choices.
MHT doesn’t fix everything! Lifestyle and other solutions also sit in the toolbox.
RESOURCES
The Lancet Series – An Empowerment Model for Menopause
Jean Hailes: The impact of symptoms attributed to menopause by Australian women
