THE MEDICALISATION OF MENOPAUSE
Menopause is a natural event when a woman’s periods stop. However, since the first half of the twentieth century, it has become medicalised and treated as a disease by scientists, doctors and the pharmaceutical industry. In recent years, non-medically trained “celebrities" have gotten on the menopause bandwagon to promote the negative aspects of menopause and the expectation that HRT will provide all the answers.
According to Elizabeth Watkins, professor of health sciences, the medicalisation of menopause began in the 1940s and 50s when oestrogen was prescribed as a short term treatment for menopause problems. The 1960s and 70s saw a surge in hormone therapy as menopause received the new definition of an “oestrogen-deficiency disease” by endocrinologists. In 1954, E. Kost Shelton, professor of medicine at UCLA, promoted long-term hormone therapy as a remedy for menopausal woes and a means of maintaining “a youthful appearance, a positive attitude, and a happy marriage.” That narrative still persists in the media that somehow a woman needs HRT to hold back ageing and prolong her youthfulness, marriage and life.
A recent analysis published by Australian obstetrician/gynaecologist Martha Hickey in the British Medical Journal, makes the point, “If you have a medication that half the population should be taking, then that’s an enormous profit.”
HRT might be seen as a quick fix for time-pressed doctors. Prescribing a hormone instead of sitting down and investigating the correct causes of a patient’s symptoms is an easy option. I have seen a number of cases where menopause was mis-diagnosed and HRT mis-prescribed due to failure to recognise real underlying medical issues like hypothyroidism and chronic infection. In these cases, the symptoms falsely ascribed to menopause did not clear up with HRT but got worse.
I remember going to see a local GP in my early forties when away on a training course. As it turned out, I had a virus. However, the GP thought my symptoms were menopausal despite having no pre-menopausal symptoms. As I left his office without a prescription, he shouted belligerently, “You’ll be back!”
While the media continues to highlight the worst aspects of menopause, statistics show that only a small proportion of women opt for HRT. In some parts of the UK, this is as low as 10%. Not every GP is keen to sign women up for HRT. I remember having a conversation a number of years ago with a GP who said that HRT might just be the biggest medical mistake of the 20th century. Recently, Dame Clare Gerada, President of the Royal College of GPs criticised the focus on the menopause, saying it is not an illness but a process you go through.
Let’s take a look at why the process of menopause can be challenging for some and what you can do about it. This is especially important if you are taking HRT and supplies run short again as they did in 2022. The menopause is a natural process that occurs when the ovaries run out of eggs. Sometimes the ovaries have a surge of activity and periods can be erratic for a while. The menopause is “official” after a year without periods. You can predict when this might happen by doing some lab tests - antimullerian hormone, inhibit B and FSH.
Problems and symptoms occur in menopause chiefly because of falling levels of oestrogen and progesterone. HRT postpones this inevitable occurrence. After the ovaries have failed, the body’s backup system for producing a smaller amount of sex hormones are the adrenal glands and body fat.
Lots of symptoms have been attributed to menopause but only hot flushes and vaginal dryness have been clearly linked to menopause in the scientific literature. This means that when women of a certain age go to their GP with symptoms of fatigue, anxiety, weight gain, poor sleep etc., they should not automatically be put down to menopause. Instead, these symptoms should be thoroughly investigated for underlying causes.
Women in good overall health generally have a smoother transition through menopause. The better shape you are in, the smoother natural events occur. Working to help women move smoothly through menopause over the years, there is a pattern of unaddressed underlying health issues I have observed which makes the menopause transition more problematic. These are:
Adrenal gland problems - the adrenal glands deal with the body’s hormonal response to stress. As these are the menopause backup system, any adrenal dysfunction will naturally affect the amount of backup oestrogen and progesterone produced. Anything stressing the body can deplete adrenal hormones. This includes mental and emotional stressors as well as physical stressors like toxins and infections.
Chronic infections (viral, bacterial, fungal/mould, dental, gut, sinuses etc.) are a huge drain on body resources and upset the body’s hormonal systems. To feel well, you need to get them identified and addressed.
Thyroid problems - these need to be identified correctly and then corrected for your entire hormonal orchestra to work efficiently.
Toxic overload - many women are carrying around toxins like heavy metals and mercury from their old dental fillings. If you have mercury fillings, mercury leaches into your tissues every time you eat, drink and brush your teeth. Menopause is often a wakeup call to get old amalgam fillings safely replaced.
Blood sugar imbalances - It is very important for all body processes to maintain blood sugar levels within a narrow range. If they fall too low, energy to the tissues and particularly the brain, is impaired. If too high, this damages arteries, the end result being heart disease and strokes. A diabetic flush looks very similar clinically to a menopause flush. The problem is that the standard western diet is full of refined sugars and carbohydrates the human body was never designed to eat. A compounding issue is that sugar is so addictive.
High inflammation - from allergic foods, gut related issues, chronic infections, toxins, EMF radiation etc.
Nutrient deficiencies - with age, the body becomes less efficient at making certain key molecules that keep the body running efficiently. That means we have to work harder at digesting and absorbing our foods and choosing our supplements wisely. For example, the now nutritionally discredited ‘low fat’ diet so much loved by the media, can keep women short of the raw materials needed to make backup menopause hormones.
Immune imbalances - when people have unaddressed chronic infections or exposures to environmental toxins like mould or EMFs, their immune system can get stuck and symptoms get worse. One particular stuck position of the immune system helps ramp up the histamine response, a common symptom of which is increased flushing. A histamine flush looks very similar clinically to a menopause flush.
All of the above underlying health issues can and should be addressed to give the best chance of a smooth transition through menopause. To identify what factors may be involved, this needs a thorough case history which is why my initial consultation is 90 minutes, not 15 minutes. The right lab tests can give more clarity about the underlying causes. Sometimes, patients with menopausal problems are puzzled as to why I don’t just adjust their hormone support instead of exploring other factors. I explain that everything in the body is connected, that I work from evidence-based medicine backed, and if they have spent the last three years trying out various sensible hormonal support without success, the real cause must be something else.
Therefore, to sum up, I would like to stress the positive side of menopause:
If things are not going as smoothly as you would like, treat this as a wakeup call to get your health in better shape by finding out and addressing the underlying causes. Your body may be telling you of the need to make lifestyle changes. This proactive approach is your best insurance policy for a healthy and happy old age.
Menopause provides less exposure to oestrogen and progesterone which are growth promoters and therefore, risks for cancer. Perhaps Mother Nature knew what she was doing in designing a wind down system at this time of life.
Freedom from the monthly menstrual cycle and its inconveniences, including expenses.
Freedom from the worry of pregnancy.
If you are worried about ageing and losing your looks, this is your opportunity to do your own research into the Functional Medicine approach to menopause and evaluate the media approach with a more critical and informed eye.
If you would like to know more about how to improve your health while going through the menopause, please contact the Good Health Clinic on goodhealthclinic@outlook.com to request a free 30 minute Enquiry Call or book an appointment.