Norman Swan: A number one professional within the menopause warns that we’re over-medicalising this inevitable transition in ladies and creating self-fulfilling expectations based mostly on worry. Martha Hickey is Professor of Obstetrics and Gynaecology at College of Melbourne, and her analysis group focuses on menopause and wholesome ageing in ladies. I spoke to Martha earlier.
Martha Hickey: Thanks, Norman.
Norman Swan: Now, you argue strongly that we’re in danger (if not, we’re already doing it) of over-medicalising menopause. What do you imply by that?
Martha Hickey: What I imply is that each one ladies will expertise one thing, so not even like being pregnant that not all ladies expertise, that is one thing that each one ladies expertise. It is a pure transition that shall be related to hormonal adjustments that may be related to signs. However my occupation in gynaecology definitely are describing this as an endocrine deficiency illness, in the identical means as diabetes or thyroid dysfunction, so a illness requiring substitute of the hormones which have been misplaced.
Norman Swan: However it’s not a illness, it is a pure development in life.
Martha Hickey: It is a pure development of life. And actually what we have found is that should you give ladies who undergo menopause potent intercourse steroids for many years and a long time, unhealthy issues will occur.
Norman Swan: Corresponding to?
Martha Hickey: Nicely, breast most cancers can be the principle factor. Breast most cancers threat is elevated with what’s known as mixed menopausal hormone remedy, in order that’s a progesterone or progestin mixed with an oestrogen, and that threat goes up, the longer that you just take it,
Norman Swan: We’ll come again to the therapy in a minute. However what you are seeing is that a few of your colleagues are defining this as a illness. And often when that occurs, the pharmaceutical business is behind it as a result of if in case you have one thing that is a illness, you may flog a drug.
Martha Hickey: Nicely, look, should you’ve received a drug that half the inhabitants has to take, then you are going to make some huge cash.
Norman Swan: One of many factors that you just make in a paper within the British Medical Journal, which is one thing we have lined earlier than on the Well being Report however not for some time, is that there is fairly a considerable variation all over the world in how ladies expertise menopause. Do we all know why that’s?
Martha Hickey: No, we have no thought why that’s. And biologically, plainly ladies are going by means of the identical course of, however experientially and symptomatically, it’s extremely, very totally different. What’s common is {that a} proportion of ladies (on this nation it is in all probability about 20%) will not have any signs in any respect. For people who do, then what they expertise could be very totally different in several nations and, actually apparently, they could purchase the chance once they transfer. So should you grew up in South India the place ladies do not are likely to have scorching flushes, and you progress to the UK, you would possibly then expertise menopause with scorching flushes.
Norman Swan: Is that this about expectation? What are we speaking about right here?
Martha Hickey: It is sophisticated, is not it? I imply, it is clearly about hormones to some extent, however it’s additionally about expectation and context. We will not change the pure hormonal adjustments of menopause, however you may change the context. So for instance, ladies have mentioned that the worst time for them to be having menopausal signs, scorching flushes notably, is at work as a result of they really feel embarrassed, and folks could make feedback about them. So you may say, okay, go and take hormones and then you definitely will not get scorching flushes at work. Or you may say, let’s change the office and make it extra inclusive and extra acceptable and recognise that ladies could have this short-term interval of difficulties with signs.
Norman Swan: What’s the function of expectation?
Martha Hickey: Look, it appears to be fairly substantial. And I believe a superb comparability may be about labour and supply, that we do not try to frighten ladies earlier than they go and have a child about what would possibly occur as a result of we recognise supporting them and giving them confidence might be useful. For menopause, it has been proven that ladies who go into menopause anticipating it to be a nasty expertise, usually tend to have a nasty expertise.
Norman Swan: So there is a job of society to be completed about normalising this?
Martha Hickey: I believe so. And actually, we all know from Covid that we’re counting on important staff in well being and schooling, and we all know that the majority of these are ladies. We actually cannot afford to disregard the well being and well-being of ladies as they transition menopause and past.
Norman Swan: For non-binary individuals who have ovaries, how do they expertise menopause in comparison with individuals who establish as ladies?
Martha Hickey: Yeah, I believe there’s little or no recognized about that. It is a hole. And people folks could also be taking or are more likely to be taking different hormones.
Norman Swan: Okay, discuss to us about remedies.
Martha Hickey: Nicely, I believe the very first thing to say is that the majority ladies do not wish to take therapy for menopause until they have extreme signs. So it isn’t menopause therapy, it is ‘what are the choices in case I want them’. For many who do need therapy, we have now received fairly a wide selection, truly, we have drug-free remedies that focus round specialised form of cognitive behaviour remedy, which works on the way you reply to the expertise of getting a scorching flush, so it makes them much less bothersome or troublesome. And for individuals who wish to take a drugs, we have menopausal hormone remedy, which has been long-standing.
Norman Swan: I additionally perceive that you’ve non-hormonal remedies.
Martha Hickey: Sure, that is proper. So, they don’t seem to be as efficient because the hormonal remedies. However for girls who do not wish to take hormones, who cannot take hormones, then they are a fairly good choice. So in Australia, we do not but have…there are new focused therapies. We do not have them but, we could have within the subsequent few years. However in the meantime, a number of the antidepressants and a few medicine used for overactive bladder or for power ache additionally cut back scorching flushes.
Norman Swan: And with hormonal remedy, there was an enormous randomised trial which we lined intimately a few years in the past on the Well being Report, the Girls’s Well being Examine, 60,000 ladies, and that has created a worry of hormone substitute remedy. Are you able to simply put that into perspective for us, if ladies want HRT?
Martha Hickey: Yeah, positive. So, that massive examine, the Girls’s Well being Initiative Examine, was designed to reply the query: Does menopausal hormone remedy stop coronary heart illness? And it did not do this, it truly elevated ranges of coronary heart illness in older ladies. And it additionally elevated breast most cancers and stroke. So the trial was stopped early due to these dangers. So what we’ve got now’s for much longer follow-up from that examine. And it is largely reassuring about youthful, postmenopausal ladies, so ladies at form of 50 to 59 years, when it comes to coronary heart illness, however the breast most cancers threat remains to be there.
Norman Swan: So is there a time restrict? If you are going to go on it, is there a time restrict?
Martha Hickey: It is a actually troublesome query I believe as a result of breast most cancers threat does enhance from the beginning, and it will get increased with longer use. You’ll be able to take it for 5 years, however the issue with that’s whenever you cease, various ladies can have resurgent signs. It is perhaps that you just’re simply placing it off.
Norman Swan: So what I take from what you are seeing is that is regular, do not panic, and there are all kinds of the way to help.
Martha Hickey: That is proper. And there are literally many very constructive issues about being a postmenopausal lady. So, youthful lady shouldn’t be frightened about what’s coming.
Norman Swan: Martha Hickey is Professor of Obstetrics and Gynaecology on the College of Melbourne and the Royal Girls’s Hospital.
