Managing menopausal women with HRT is the most rewarding part of my job as a doctor. Many women tell me that the HRT I have prescribed for them has given them their life back, their energy has returned and their relationships with their partners and their children has improved. In addition, women often tell me that they have more confidence, they are no longer in a “bubble” and they are so much happier and content with their lives since they have been taking HRT.
The vasomotor symptoms of the menopause are the ones that are most obvious when thinking about the menopause, but these are not the symptoms that affect patient safety the most. It is the symptoms of low mood, anxiety, low self-esteem, poor memory and concentration, no libido and the vaginal dryness that affect them the most.
The British Menopause Society (BMS) conference was recently held in Kenilworth, Warwickshire, and it was a stimulating couple of days. The lectures were informative and varied and the meeting is always a fantastic opportunity to catch up with colleagues, many who are equally as passionate as me regarding prescribing HRT and helping women to have a positive experience of their menopause.
Unfortunately, there are still many healthcare professionals who are less passionate and sometimes very negative about prescribing HRT for women. I frequently hear stories from women telling me that they have been refused to be prescribed HRT, which is going against current guidelines available for the management of menopause which we should be working from.1,2,3
Giving HRT improves symptoms and allows women to have a better quality of life than they had previously. However, there are health reasons to consider HRT for many women. There is now overwhelming evidence that HRT is effective at reducing both cardiovascular disease and osteoporosis in the future, when given within 10 years of the menopause.4,5
In the UK alone, annual hospital costs associated with osteoporotic hip fractures are estimated to be £1.1 billion. Osteoporosis is not a UK problem and the prevention of fractures in postmenopausal women is a vital public health priority worldwide.
The new chair of the BMS, Kathy Abernathy, talked about an important review paper that was recently published, and which discussed how the presence of vasomotor symptoms during the menopause may be associated with a higher risk of conditions in the future.7 Women with moderate or severe vasomotor symptoms have been shown to have a lower bone mineral density (at the femoral neck and lumbar spine) and increased rates of hip fractures compared with women who did not have vasomotor symptoms.8
There is also evidence that women with vasomotor symptoms have a worse cardiovascular risk profile (increased risk of CVD, CHD, or ischemic stroke) compared with women without vasomotor symptoms. Women experiencing vasomotor symptom have significantly higher systolic and diastolic blood pressures, higher circulating total cholesterol levels, and a higher body mass index than their counterparts with no symptoms.
Prevention of both osteoporosis and cardiovascular disease in women, as for men, should be started early. Effective management of chronic diseases in postmenopausal women surely needs to start with the awareness that vasomotor symptoms during menopause are harbingers of things to come and should be treated accordingly.
Although the menopause is not a disease, I feel that a consultation about the menopause should be seen as an “opportunity”. This is because correct medical intervention and advice at this point of life can offer women years of benefits from preventive health care. Many GPs are medically managing the menopause with antidepressants, which goes against current guidance. The majority of women who come to see me in my menopause clinic have been inappropriately given or offered antidepressants for their symptoms of low mood associated with their menopause. This shows that many GPs are either not thinking about the menopause or are not confident in prescribing HRT.
There is still considerable confusion about HRT and this needs to change. Much of the confusion has arisen from inaccurate media reporting of large studies, which has resulted in too many women not receiving HRT and so are living with dreadful symptoms.
Women are also often needlessly suffering at work too. I work closely with West Midlands Police and the Fire Brigade helping their menopausal women at work. A recent questionnaire undertaken by West Midlands Police has shown that over 80% of women had symptoms which affected them at work. Perhaps more concerning was that 77% of women did not realise their symptoms were even due to their menopause until they had been given information about it.
As we are all working for longer and retirement age is increasing, there has never been a better time for companies to help menopausal women at work. Recent Faculty of Occupational Medicine guidelines have been produced and companies need to engage with these.
I feel very passionately about helping menopausal women have clear advice which is based on sound evidence and current guidelines. Healthcare professionals need to be empowered with more knowledge and experience to correctly manage the menopause so women do not have to have their lives ruined by their symptoms and can be offered a treatment that can also invest in their future health. I cannot honestly think of any other guidelines that are ignored as much as the NICE guidelines on the diagnosis and management of the menopause. This needs to change!
- Louise Newson is the consultant editor of BJFM’s
supplementary journal, Women’s Health, and also runs
the website www.menopausedoctor.co.uk