DR MAX PEMBERTON: This is one of the reasons women feel anxious during the menopause… and HRT won't fix it

Thankfully, there has been a significant shift in many doctors’ attitude towards hormone replacement therapy (HRT). It won’t come as a shock to most women reading this that, for far too many years, peri and post-menopausal women have had to fight for their right to access this medication.

Finally, an increasing number of doctors are open to the idea that prescribing HRT can have real benefits for their patients – and undoubtedly for many women this has made a life-changing difference.

Even though 13million women in the UK are going through the menopause, it is estimated that one in four have to visit their GP at least three times before getting appropriate treatment.

Last year’s official draft guidelines advising GPs to consider alternative treatments, such as talking therapies ‘alongside or as an alternative to’ HRT to help reduce menopause symptoms –such as insomnia, low mood and hot flushes – have now been revised. 

Dr Max believes believe low mood and anxiety during menopause are a result of complex social and psychological factors, rather than simple biology

Health officials backtracked after accusations of ‘medical misogyny’, the implication being that menopausal symptoms were ‘all in the mind’.

Indeed, this week NICE changed its guidance, advising that HRT should be offered as the first line of treatment.

A positive development you might think, but I’m not sure. Regular readers will know I am quite a fan of HRT and have seen many patients’ lives transformed by it, but HRT isn’t suitable for everyone and talking therapies can help women presenting with symptoms that have a psychological component.

For instance, many women talk about no longer feeling like themselves, a disconcerting sense of something having changed; a vague undercurrent of unease, despair and discombobulation. 

But what causes all this turmoil? Can this be put down to simply a blip in hormones that’s addressed by HRT? Can we explain away a woman’s dissatisfaction with life and her sense of loss and malaise as a chemical reaction? I honestly don’t think so.

I believe it’s far more complicated than that.

That’s not to say that hormones don’t play an important part, and this is one of the reasons I’m an advocate for HRT. We know fluctuations in hormones can be directly responsible for low mood. 

Over the years, I’ve seen far too many women struggling to cope and for whom HRT has been a godsend – helping them manage anxiety triggered by the menopause.

But I do think there are other factors that contribute to a woman’s sense of losing herself. I strongly believe low mood and anxiety are a result of complex social and psychological factors, rather than simple biology. 

Changes to the body, disrupted sleep, hot flushes and so on can make any woman feel out of control and depressed.

But there are other issues I’ve heard women talk about – for example, erratic mood swings and out-of-character behaviour. I’ve heard stories of women having affairs, quitting their jobs or leaving their husbands around the menopause.

While some would seek to blame this all on fluctuations in hormone levels, actually the evidence isn’t that compelling. 

It’s not at all clear that drops in oestrogen and progesterone, the female sex hormones that start to decline in menopause, are entirely responsible.

Instead, I believe the menopause acts like a ticking clock. It suddenly makes women open their eyes and review their lives.

I believe a lot of the trauma and emotional turmoil that besets many women as they navigate menopause isn’t the consequence of fluctuating hormones but of a re-evaluation of their situation. 

For many, their sense of self and identity is closely bound up with their roles within their family, particularly those who are mothers, who may feel bereft at the prospect of an empty nest.

It is also a cruel aspect of the inequality between the sexes that women have to contend with a society that’s more judgemental about how women age than men.

For a lot of women in their 50s and 60s, they have given the best years of their lives to other people and their careers, and now, they’re not sure why. 

They feel they’re now invisible. I’ve had so many menopausal and post-menopausal women attending my clinics and telling me they no longer feel like a woman. It’s incredibly sad.

These people would surely benefit from having the time and space to explore and discuss their feelings and situation? That’s where talking therapies can play a vital role for many who are desperately unhappy.

In my opinion, the answer to many complex problems precipitated by the menopause aren’t always going to be found in HRT pills, patches and gels.

I know why Coleen’s so worried 

Coleen Rooney has reactive arthritis – which is caused by an infection but may also be brought on or exacerbated by stress

Coleen Rooney, strongly rumoured to be heading into the I’m A Celeb jungle this Sunday, has been through a lot over the years. From the Wagatha Christie case featuring fellow WAG Rebekah Vardy to husband Wayne’s cheating scandals – all must have taken their toll.

So, it was no surprise to read Coleen has reactive arthritis – which is caused by an infection but may also be brought on or made worse by stress. Sufferers have painful joint or joints which can impact their mobility and mental health. ‘It caused anxiety and there were lots of tears,’ said Coleen, discussing the condition. ‘It was not a nice place to be.’

My mum developed reactive arthritis after a bout of food poisoning. While waiting for a knee replacement op, her world shrank with the pain. It can steal your independence and sense of joy.

The Advertising Standards Agency issued a warning to a GP surgery after it misled patients about the level of training physician associates – or assistants as I call them – have had. 

The GP practice website stated that PAs ‘train in and are examined in all areas of medicine’ and that training ‘encompasses medication and prescribing, just as a trainee doctor would receive’. 

In fact, PAs are not trained in all areas of medicine and the surgery was warned not to conflate the roles, training and duties of PAs and GPs. Worryingly, this is not an isolated incident and feels like an attempt to hoodwink the public.

In Bradford, a series of posters designed to show the range of healthcare workers in GP surgeries used words such as ‘physician’ and ‘cancer specialist’ to describe PAs. This is disgraceful and only causes confusion among the public.

 Few doctors who are not consultants in oncology would ever dare describe themselves as ‘cancer specialists’. How is it OK for people who are not even doctors to do this? Is it any wonder that people are confused whether they’ve actually seen a doctor or not when there are adverts like these?

Dr Max prescribes…

5 minutes of exercise

 

It’s hard to find time to exercise, given our busy lives. 

People often think if they can’t find the time for an hour in the gym or a long walk, then there’s no point. 

Which is why a new study revealing we only need five minutes of vigorous exercise a day to help lower blood pressure is the perfect tonic. 

We can all find time for that!