The menopause is having a moment. Once only spoken of rarely, and with embarrassment, it is now sensationalised in the media. This has been accompanied by a massive increase in prescriptions for Hormone Replacement Therapy, which have more than doubled in England in the past 5 years. But is this hormone revolution really helping women?
It is true that misogyny prevails in the medical profession and that women’s healthcare is often overlooked and under-researched: just look at the current attitude towards endometriosis and the crisis in childbirth and after-care. But there is a greater philosophical question here that needs to be interrogated: Is menopause a disease of oestrogen and ageing that should be treated? Or are we instead pathologising and medicalising a normal part of the female life cycle?
This week, The Lancet medical journal published a series of articles examining the current media narrative, saying it’s “time for a balanced conversation about menopause”. Its editorial states that, while some women experience severe symptoms, others have mild or no symptoms. And despite the frequent claims that menopause is associated with poor mental health, it states that “there is no strong evidence that the risk of first-onset clinical depression is increased over the menopause” — although some women with previous mental illness may be at risk.
Menopause wasn’t always taken so seriously. There was a time when women were expected to shut up and put up with their hot flushes. We darkly referred to this stage of life as “the Change”. But then, the bestselling book Feminine Forever, by gynaecologist Dr Robert Wilson, changed that narrative forever. He made the case that menopause was a serious disease and that post-menopausal women were deficient: “a woman’s physical, social, and psychological fulfilment all depend on one critical test: her ability to attract a suitable mate and to hold his interest for many years.” He described menopause as “a mutilation of the whole body” and HRT was a way to “be restored along with a fully feminine appearance”.
Though some feminists fought back, many health activists embraced the view that, like contraception, HRT was a key to women’s liberation. But what wasn’t common knowledge at the time was that Wilson was funded by the HRT industry.
There followed an inevitable surge in demand for HRT until, in the early 2000s, a large study from the Women’s Health Initiative reported an increased risk of breast cancer associated with long-term HRT use. Overnight, the treatment fell out of fashion. That study has now been contested, and in the past decade, the medication has had a renaissance. Parliamentarians are calling for menopause health checks, and leave from work, and social media is full of doctors recommending it to women — and women recommending it to each other — not just as a way to reduce hot flushes, but as a way to save marriages, skin tone, and sex lives — as well as reducing future cardiac and dementia risks.
Join the discussion
Join like minded readers that support our journalism by becoming a paid subscriber
To join the discussion in the comments, become a paid subscriber.
Join like minded readers that support our journalism, read unlimited articles and enjoy other subscriber-only benefits.
SubscribeI can only go from my mother’s experience. She was advised to take HRT at the onset of perimenopause, which she duly did as the advice came from her Doctor. She was on it for years and eventually they upped the dosage. Then she found a lump in her breast and was diagnosed with an oestrogen eating form of breast cancer. The doctors said it absolutely wasn’t connected to HRT however she was to stop taking it immediately. On doing so, all those symptoms that she had been trying to avoid with HRT, returned and had hot flushes, night sweats etc till her cancer returned and killed her.
Consequently, my sister and I have decided to try other approaches including learning to live with the change.
It really shouldn’t be this way, but the medical profession are prone to being influenced by the pharmaceutical industry, “with incentives”.
Hope your experience, and that of your sister, is so much better.
Thank you
I think that more open dialogue is good. I believe that there are, undoubtedly, some women who suffer more than others that will benefit from HRT but the benefits have to outweigh the risks and they don’t in all cases. It’s very much like the pill, we don’t have the full picture of the long term consequences, we’re only now starting to get an understanding. I sometimes think that the pharmaceutical industry see society as one big test subject, here for their convenience.
No, it shouldn’t be. But we are inundated with Pharmo commercials and advertisements, so no wonder people are now diagnosing their own “maladies” and requesting a quick fix via a drug. People need to wake up. I’m having a birthday celebration this evening for a chap who is 93 years old. He doesn’t take, nor ever has taken, a single prescription in his lifetime and even refuses to swallow an aspirin when he has an ache or pain. I want to live like that!
Well good luck with that, it’s all genetic.
Sorry to hear about your mother.
But n=1
As they say in Australia, “everything you say before the ‘but’ is BS”
It’s not just an Australian saying, it’s a truism.
HRT killed my mother at age 68. She died of an abdominal aortic aneurysm – commonly associated with hormone replacement drugs but not commonly disclosed.
Women have always lived with the change, just as we did with our monthly periods. Messing with our natural life cycles is only beneficial to the pharmaceutical industry.
I’m very sorry for your loss. Best wishes to you.
Both my sisters have had breast cancer in the last year. They were both on HRT, and now can not only not take HRT, but have to have oestrogen blockers as well as part or all of their breasts removed. I’ve experienced medical gaslighting myself, I think it’s a massive problem with medicine, but to deny the supplemental oestrogen medication you were prescribed had anything to do with what’s officially called oestrogen receptor positive breast cancer beggars belief.
There is micronized progesterone and also hormones that are chemically the same as natural hormones. That sounds a bit vague because it’s been many years since I had to deal with it, but worth investigating for those who are still struggling.
This is an interesting article, but it’s not nuanced enough to be helpful. HRT covers a wide field of treatments: different combinations of different hormones, delivered to different parts of the body.
To lump them all into a single pot labelled’HRT’ and cherry-pick risks and benefits out of the pot is about as useful as lumping all the politicians in the House of Commons into one bucket marked ‘MPs’ and selecting political views and opinions from individual politicians as representative of the whole lot.
Well said, for example the oestrogen tablets mentioned in the article are rarely prescribed now. Oestrogen is mostly delivered by a transdermal gel or by an adhesive patch.
“It is true that misogyny prevails in the medical profession”
Really? Most doctors and nearly all nurses are female, so this sounds like sloppy thinking – repeating a trope rather than making a case.
Misogyny is not unknown among women, or so I have been told.
Looks like “misogyny” no longer has a fixed meaning. I typically ignore references to it, until someone can specify the behavior that they believe justifies the term.
That sort of jumped off the screen. And “it’s true” because, well, the authors said so.
This bothered me too. I think it was a generally thoughtful article (mind, I’m only a witness to this part of life, albeit, at close quarters).
The other little gem about women worrying about the gender pay gap didn’t help.
However, I did think it fairly nuanced; I have seen the articles about HRT saving marriages and sex lives which I found quite distasteful.
Most doctors female? Nah.
Drug companies on the sell. Menopause is a natural part of life, it passes and you move on. Eat a healthy diet, and stop medicalising every little glitch. Mine was in my early 50s, I have never taken hormones of any kind. Life has its ups and downs. I have a large varied family. But I am still singing in public, and I was born just before D-Day, work that out for yourself. Singing is a great life enhancer.
For others it’s unending misery – hot flashes are the least of it. The difference between my quality of life on HRT and off is enormous. Poor vision, heart valve issues, painful joints, erectile dysfunction – even cancer – are natural parts of growing older – but we never consider not treating these!! More women are living decades longer than ever in recorded history. For those women blessed with an easy menopause, God love ya. Please don’t dismiss those of us who haven’t been so fortunate.
Exactly. Veronica sounded so smug.
That may be your experience but we’re all different, and there seems to be a genetic factor. For a lot of women, it is truly ten years of hell.
Against the backdrop of a blooming vagina, Gwyneth Paltrow unveils a new line of scented candles that smell like her orgasm.
LOL!!!
I really didn’t need to read that today.
Love the picture and caption:
“Gwyneth Paltrow has opened up about menopause”
and looks like she is about to disappear up her own fanny.
Or to use the language of the Gods, Latin, her own CUNNUS.
“women’s healthcare is often overlooked and under-researched”
What rubbish.
Funding for women’s health far exceeds that for men despite the NHS being almost entirely funded by male taxpayers.
Certainly believe that the research etc in breast cancer massively outranks prostate.
HRT. They’ll have to prize it out of my cold dead hands.
The menopause is just being weaponised by third wave feminists.
A good question to always ask is: why, in certain commonplace life situations, is the body doing xyz – is there possibly a benefit? For example, adrenalin doesn’t make you feel good, but it can give you a burst of strength to survive certain kinds of danger. And it turns out that in the case of some of the “symptoms” of menopause, they might actually be a valuable element of the transition. A 2011 study (easy to google and find many sources) found that: “women who experience hot flashes and other menopause symptoms may have a 50% lower risk of developing breast cancer than women who have never experienced these symptoms. Another 2011 study found that women who experience hot flashes and night sweats around menopause have an 11% lower risk of heart-related health problems and an 8% lower risk of dying from any cause over a 10-year period. The study also suggests that these women may be protected from heart disease, stroke, and even death years after menopause. (Hutchinson Center research) Another study found hot flashes to be associated with protective chemicals increasing in the brain.
This research just kind of slumbered away … because it was not good news for the pharmaceutical industry.
I never heard about that– thanks for the information.
It’s so interesting to hear that. I think the question that is never asked is why some women experience symptoms while others do not.
This is so interesting to read. It reminds me of the recent change in medical advice around taking paracetamol to lower fever. Turns out the “symptom” of fever is important and beneficial to help the body fight infection, so automatically lowering your temperature with unnecessary pharmaceutical intervention isn’t helpful unless your fever is dangerously high. A misread by doctors who turned a beneficial change in the body into a pathology that needs to be corrected with medication.
So true.
Or because it was about women. Until very recently there was no research on heart disease in women, all the research was done on men, despite the fact that after age 50 more women die from heart attacks than men.
For years, they only talked about the risks, which turned out to be from a flawed trial and well before more modern advances in medicine. Women deserve the right to take HRT if it can help their menopause symptoms. They were often denied that right until doctors started tossing around hormones like they were candy to people if the opposite sex. Doctors prescribing them responsibly across the board is the answer. Too bad we can’t count in doctors anymore.
In the early 70s I came off the pill as I had put on weight within 6 months and realised that this was a powerful drug that had no really long term studies as yet.
In my late 40s, my surgery persuaded me to try HRT. I watched the videos. tried it for 2 months and yes, it took away the hot flushes immediately. However, I thought again that this was a drug which had to be very powerful and that I could be on it for many years. I would then have to experience the menopause. So no HRT either.
I think the current hysteria is ludicrous and most women are not suffering dire symptoms nor do they need time off work. That is an open invitation to skive and is patronising in itself.
I suspect you are right, but it is not unreasonable to gently remind men that the process can be tough and that some (informal) allowance might be helpful.
Rubbish, you don’t know enough women to make that call. And what’s with your “surgery”?
I am so glad to finally see pushback to the latest promotion. I was premenstrual during the last one when my US gp wanted to prescribe it “prophylacticly”. Being a skeptic & asymptomatic, I declined, saying that if it became a problem I would reconsider. It didn’t. When the cancer study came out it confirmed what I had thought was common sense about hormone treatments & I realized that my gp never met a pharmaceutical representative he didn’t believe.
Your health status going into menopause matters. Women need to move a lot more, weight train to maintain muscle mass, eat more protein, ditch the wine and find new hobbies that don’t involve their phone. I suspect the correlation between healthy weight and number of symptoms is solid. Harder than taking a pill though.
That’s very preachy.
Happy to be frankly. We are societies of victimhood and laziness endlessly seeking a pill-shaped cure.
Big pharma is doing this for men too. Low testosterone, or low t, doesn’t seem to have existed until about ten years ago, and now there are pills to ‘ask your doctor’ about as well as dozens, maybe hundreds, of vitamins and supplements that claim to increase testosterone levels. I’d be shocked if big pharma wasn’t a major backer of whatever medical research led to this becoming a recognized medical problem. Like most companies, they’re large and powerful enough to influence scientific and public opinion. It’s a price paid for letting these companies get so large and subjecting them to so little scrutiny for so long.
I see it as part of man’s eternal anti-aging quest. People have been inventing folk remedies with animal parts since forever. There are all sorts of stories and legends dubious in origin about people using strange and often horrific methods for achieving eternal youth. Hernando De Soto spent several years wandering around what’s now Florida looking for the literal fountain of youth. So far, modern medicine’s attempts haven’t been much more successful than any of the earlier ones, but they have been more successful at making money from them.
My husband has low testosterone and has had it for many years. It caused him to have severe brain fog. He couldn’t figure out how to do simple tasks that he used to be able to do without thinking. We feared it was dementia, but a blood test revealed really low testosterone and he was put on testosterone replacement. No reason for the reduced testosterone was even diagnosed. He immediately regained his brain function and is able to lead a normal life.
6 years ago he was diagnosed with prostate cancer and had 8 weeks of radiation therapy. The oncologist also wanted him to go off his testosterone as normally prostate cancer is treated with testosterone lowering drugs to lower the risk of re-occurence. He refused as he had no desire to return to the brain fog life. The oncologist accepted his decision and annual PSA tests have not shown any sign of the prostate cancer returning.
The question that never seems to be asked is: why do some women experience symptoms at menopause while others do not?
I did experience hot flushes and strange feelings as a result, but I decided against HRT. I used Ayurvedic medicine to take the edge off the hot flushes – not a hormonal medication but one that reduces heat in the body. But the question of why really bugged me, sp I observed carefully over a long period to see what happened during hot flushes. I have come to the conclusion that they are connected with the fight-flight-freeze hormonal system, with adrenaline. I have also reached the tentative conclusion that long-held in habits of emotional reaction were at the root of this. Gradually as I worked to ease these reactions and was able to be more relaxed, the hot flushes ceased. It took years, but I am left with the strong suspicion that differences in emotional wellbeing may be one reason why women have such varying experiences.
For those who struggle but wish to avoid HRT, I do suggest trying Ayurvedic treatment.
Menopausal symptoms are mostly genetic.
Follow the money. Look for an mRNA therapy soon.
Man have viagra, should a wife live the other way when a husband visits a prostitute? Or should she take harmones?
And lie with a husband.
Thanks for this article. I am relieved to see people questioning the current propaganda/narrative. I am 60 years old and went through the menopause 10 years ago. I agree with the ‘biopsychosocial framework’ mentioned by Myra Hunter. The hormonal changes of menopause fundamentally altered my body and, at the time, working in a very stressful job combined with various social stressors, I then experienced a number of physical health issues over the next 8 years. At the age of 50 I didn’t take HRT as the fears around breast cancer were still prevalent. However by the time I was 58 the whole culture had shifted and after listening to radio programmes and reading articles I began to believe that taking HRT would solve the various physical issues I had experienced. I also felt fearful that by not taking HRT I was not doing enough to reduce my likelihood of contracting other diseases such as dementia.
Consequently at 58 I went to the most famous private menopause clinic for a consultation leading me to begin taking HRT. In their literature it stated that research studies had shown that women who were over 10 years post menopause did not gain benefits from HRT. However I was advised that I could still benefit from the medication. Straightaway the red flags were there. Although the clinic stated that HRT could improve concentration and focus ; at the consultation I was informed that testerone (available only on a private prescription) was the ‘icing on the cake’. I began HRT and after a few months began experiencing anxiety, insomnia, sensations of cold and pins and needles in my arms and legs. It was very alarming. I returned to the private clinic who allowed me to have a consultation with one of their doctors. She suggested that I needed to increase the dosage of oestrogen.
By this time I was losing confidence in the whole show. I found an acupuncturist who advised me to come off the HRT and I discovered that my symptoms were accurately described as menopause paresthesia. The sudden increase in oestrogen after my body had stabilised to lower levels of the hormone triggered the paresthesia. The symptoms which resolved when I stopped HRT.
Nowadays I am skeptical about Big Pharma and how profit-making inevitably distorts publicity and information. HRT is a great ‘success story’. Most women now take HRT as a matter of course believing that it will improve their health. The HRT industry also promotes that it is good to start early when one is peri-menopausal to get the best results. I agree that we have now swung from one end of the spectrum to the other. However I think it would be much more helpful for women if menopause was not medicalised but seen as a rite of passage which has its challenges and benefits. Perception shapes reality; if menopause is seen as a hideous distressing experience that’s what women will experience. In retrospect I believe that my menopause was a time when my body was signalling its despair at my neglect and over-riding of its messages and these illnesses eventually helped me to create a healthier and more respectful relationship with my body and nervous system. Unfortunately in the current capitalist system we live in most menopausal women are enslaved to mortgages, soul-destroying jobs whilst supporting elderly parents and adult children stuck at home. The body keeps the score (Van Der Kolk) and as with other psychological distress the industrial complex’s answer is medicate and keep on going.
Women could take the contraceptive pill every day with no break, and it would eliminate or greatly reduce monthly bleeding. Unless they’re actually wanting to get pregnant, why not just take the pill all the time? After all, it would relieve all those nasty monthly symptoms: mood swings, cramps, bloating etc. But they don’t, because menstruation is natural but the menopause is an attack on their youth
There is plenty of research, apparently, that the Pill reduces mood swings because the women are, basically, suffering PTSD and are almost sedated; it certainly frequently affects their choice in men. See How the Pill Changes Everything by Dr Sarah Hill
That’s rubbish from a man and also ignorant. Some women use that regimin and some also use an under-the-skin progesterone regimin. Do your research.
“It is true that misogyny prevails in the medical profession and that women’s healthcare is often overlooked and under-researched”
That’s not factual now.
Maybe in the past but not now.
A lot of the medical establishment are women.
And a lot of focus on women’s diseases, such as breast and ovarian cancer, screenings, drug research etc. That old misogyny trope is getting very tired.
I started training as a medical student in the late 1970s. Articles like this, in print or on TV, made similar claims to those being made here; they weren’t true then and they’re not true now. The conflicting evidence and changes in medical opinion/ fashion are features of many diseases or conditions, not just those specifically female. All treatments have potential side effects and need to be tailored to the individual, whether of either sex.
But in research?
Am I the only one finding women displaying giant stylized vaginas somewhat obscene? It started with the vagina monologues, we were supposed to celebrate the empowerment it represented. I would have preferred something like “The Oxytocin Monologues” if I were a woman – whatever, to each her own. Gwyneth P “opening up” (really…?) in front of the image of a huge gaping vagina? Who edits thesis things?
Taking HRT has changed my life for the better. I’m very grateful I am able to take it.
Me too – it has got rid of some very unpleasant symptoms and I have had zero side effects from it. I use patches, transdermal is the safest way to take HRT.
Men young and old are also on the testosterone supplementation bandwagon. I don’t think this is an issue of sexism but pharmaceuticals convincing the general population they need to purchase their products.
Women on average live longer than men, way past menopause. It drives me crazy, eighty five percent of all commercials are from drug companies including the ‘ask your doctor if its right for you” without even specifying what it supposed to cure. So we now have all these drugs looking for patients, and doctors getting a royalty for prescribing them. My answer is a 30minute walk each day, preferably with a dog.
That’s rather glib.
Hard to take this article seriously when they say: “It is true that misogyny prevails in the medical profession and that women’s healthcare is often overlooked and under-researched: just look at the current attitude towards endometriosis and the crisis in childbirth and after-care.”
Medicine is HIGHLY feminized and misandric. Male physicians have a harder time getting into certain specialties. Females make up 60% of med school entrants and new doc grads here in Canada. There are all kinds of “women in medicine” groups, funded by universities and governments. Like everywhere now, it’s fine to cast aspersion on men in medicine, while exalting females (“amazing” “brave”)
Many deep thinkers have posited that part of the collapse of medicine in The West is due to its feminization. A culture of hard work and service has given way to constant cries for more work on “physician wellness” (often, it seems, at the expense of “patient wellness”). Many female physicians try to position themselves as victims on social media. They are so hard done by trying to work AND look after home responsibilities (who could possibly hire a nanny when they make only 250K or more per year!).
As the profession has feminized, work hours are shorter, vacations are longer, careers are shorter, productivity is lower, and despite rising numbers of physicians per capita in many countries, actually finding a physician to see you when you are ill is much harder than it was back in the bad old days.
There are some benefits to the feminization of medicine. But many downsides as well. And as with many hot-button issues, we tend to only hear one side in our polarized, curated, censored and shadow-banned modern environment.
“It is true that misogyny prevails in the medical profession.”
I got as far as this misandrist opening sentence of the second paragraph then skipped to the comments section, which was informative and worthwhile reading. I am sick of the daily statements of hatred and vilification of men. Misandry is as widespread, if not more so, than misogyny – and more insidious as it is seldom if ever acknowledged, discussed and condemned as is misogyny.
Apparently it’s acceptable constantly to bang the misogyny (toxic masculinity) drum; but not OK to talk about its female equivalent. Mind you this is no more imbalanced than other cultural Marxist tropes such as White = Bad, Black = Good; Islam = Good, Christianity = Bad; Left Wing = Good, Right Wing = Bad; Activism = Good, Exgtremeism = Bad; Communisim = Good, Capitalism = Bad; Israel = Bad, Palestine = Good; and so forth ad nauseam.
Not just hot flushes! Awful aching legs, sleepless nights and exhaustion, anxiety and rage, weight gain, feelings of hopelessness, cluster headaches… I tried to push through this ‘natural phase’ for almost 10 years. I went on HRT and although it took a few months to get the balance right, my quality of life has been transformed. More energy, more sleep, less desire to strangle my husband, no more anxiety, no more headaches, no body temp fluctuations. I expect there will always be some sort of backlash saying that by medicating we are somehow failing the sisterhood by not enduring this natural progression through womanhood, but there is a huge number of women who genuinely find their lives are diminished after menopause and no amount of healthy eating is going to change this!
I have a deep distrust of the current system of medical upselling, bullying (that became evident in the recent covid times) and the invasive preventative testing that is spreading as a pathway to good outcomes.
Unfortunately, anecdotal accounts are aplenty of how someone benefited (in the short run) by certain medical treatments like HRT or weight loss drugs etc. Or we are fed some statistics that is supposed to solidify the case for these treatments. Life is a challenge in which one has choices, this has not changed from since we were mere bacteria. Response to some medical challenges nowadays in the first world has become one of utter laziness and the doctors are trigger happy to throw the pressure of vast numbers of people coming through the system by offering drugs and treatments that may be superfluous or even harmful.
This machinery we have created has no time to see an individual for their specific needs nor their ability to fight their ailments. There is feeble insistence from doctors for their patients to be mentally & physically stronger. The population is becoming weaker relying so heavily on such systems. We have become slaves to testing and therapies.
Here is another anecdote- When I was younger, I was wisely advised by one doctor when I complained about heavy painful periods even after the birth of my children that this is ‘my’ normal. I was struck by that reality.
At 50 with no menopause in sight, I took the Marena, which allowed smother transition into menopause, alleviating the discomfort of periods but have noticed some side effects now even though they are not that bad. So on reflection any intervention will have consequences and sometimes it is advantageous to take the interventions but if it means we have become lazy and unwilling to accept our bodies and take personal responsibility for them, then we have only ourselves to blame.
Knowledge is empowering yet acting on it in a careful manner is also our choice.