We are living in a Wild West era of menopause “awareness.”
Doctors, influencers, celebs, journalists, anyone with a voice can say almost anything about menopause, and HRT, with zero consequences.
The sheriffs (regulators, the free press, medical organizations) who are supposed to play a role in protecting the public from harm, in most cases, could replace their badges with rubber stamps. Silence is not an appropriate response when outrageous and unscientific claims are given a platform, and reach millions.
When it comes to menopause, medical ethics along with journalism ethics have been kicked into a dusty corner of a saloon. Once there were standards to uphold; now there are corporate sponsors to please.
Yeehaw.
Last week, I observed an online discussion started by a woman in her late 50s, who was experiencing FOMO (fear of missing out). She had journeyed through menopause with some symptoms, which she had coped with, without HRT. However, recently she’d discovered that among her friends and colleagues, she was the only one to NOT have taken HRT. She was concerned that perhaps she was damaging her health.
Those of us who work with women in perimenopause and menopause encounter such concerns frequently. We meet women who have started taking HRT, not because their symptoms were hard to cope with, but because a celeb convinced them it could reduce their risk of disease.
Just last week in The Times, we witnessed a celeb and culinary expert from The Great British Bake Off declare (in a peculiar misunderstanding of the human condition) that the "secret to happiness" is an HRT patch. A day later, an opinion piece in the same publication announced that HRT can “banish symptoms,” prevent numerous diseases, and make your skin youthful.
I wonder if The Times health editor has actually read The Blue Guide: Advertising and Promotion of Medicines in the UK, or just chooses to ignore it. The document explains why those comments should never have made it to print. Yet, they did.
Oh, it’s just a celeb, who’s entitled to an opinion, some say.
But it’s not.
It’s a business plan.
It’s relentless, and it’s harming women.
Since the 1960s, there have been doctors trying to convince women that oestrogen therapy and then combined HRT are needed for disease prevention. For those doctors, it never mattered that there were no large randomized controlled trials (RCTs) that could back up the disease prevention claims. RCTs are the gold standard for understanding benefits and risks of medicines.
Women, once considered the weaker sex, became the deficient sex, post-menopause. That was supposedly enough to explain every disease that could be found more often among older women.
The fact that men also experience more chronic diseases as they age was ignored. The fact that the risks of many chronic diseases could be reduced through better lifestyles was also ignored. It was women’s hormones that needed fixing!
Over the decades, large RCTs were carried out and it was discovered that HRT carried more risks of disease than disease preventing qualities. As a result, fewer doctors felt comfortable promoting HRT for disease prevention. Then in 2017, the findings of a groundbreaking 18-year clinical trial were published in The Journal of The American Medical Association (JAMA), causing an earthquake in the menopause world.
The authors of this research concluded that they “would not support use of hormone therapy for reducing chronic disease or mortality.”
In line with the findings of this trial, the North American Menopause Society and most other menopause societies around the world stopped referencing disease prevention as one of the benefits of HRT. An exception was in the case of osteoporosis. However, although HRT can increase bone density, the changes are reversed once HRT is stopped. For women in natural menopause, if they take HRT at midlife, they will not experience an impact on bone density decades down the line.
Strangely, the British Menopause Society stood alone in not endorsing the North American Menopause Society new policy document on HRT back in 2017. In addition, within a few years in the UK, we witnessed a backward facing revolution, which would influence how menopause was being discussed in the media. Misogynistic messaging from the 1960s resurfaced, and an aggressive fear-filled campaign to change women’s attitudes to menopause unfolded.
Since 2021, it has become common for women to be bombarded with unproven claims about HRT. In 2022, a Channel 4 documentary on menopause even contained HRT product placements, including for a testosterone product that isn’t licensed in the UK to treat menopause symptoms. Since then, the same celeb who hosted the documentary has shared a promotional video of her using testosterone. It’s bizarre! Why are there no consequences? Where are the sheriffs? The media landscape in the UK is unrecognizable.
Just a few weeks ago, a menopause influencer with a large social media following, posted information claiming that for “most women” the benefits of HRT include reducing the risks of the following: Osteoporosis by 26-37%**
Diabetes by 30%*
Coronary Heart Disease by 50%*
Dementia by 22-32%* **
ARMD by 35%*
Depression by 50%*
All-cause mortality by 30%*
She offered references for all of the above (which you can find at the end of this post), but how many women have the time, energy or knowledge to investigate if the references actually provided the evidence to back such claims? It turns out that all the references were based on inconclusive studies (*) and/or studies carried out on women whose uterus was removed (**).
A look at the reference given for dementia, highlights the weakness of the claims. The research in this case is a meta-analysis (review of past studies). The 22-32% figure refers only to data from less robust observational studies of women who received oestrogen-only therapy (which means women whose uterus was removed). Observational studies of women who went through natural menopause, plus data from the more robust randomized controlled trials for all women, show a null to negative impact of HRT on dementia. Why would you ignore more robust studies and data relevant to the majority of women?
Women who undergo a hysterectomy, especially if it's accompanied with the removal of their ovaries, can experience a rapid onset of intense menopause symptoms. In addition, they increase their risks of a multitude of diseases and conditions. HRT is often prescribed after the surgical procedure in an attempt to mitigate the side-effects of the operation. The needs of women who experience the removal of their uterus and/or ovaries are very different from the needs of women in natural menopause.
Most women go through natural menopause, which is not a trigger for disease.
All medicines carry risks and should only be taken following a consultation with a doctor. The risks of HRT are often under discussed but just viewing the product information of one HRT patch (the supposed secret to happiness), we can discover that between 1% to 10% of women who use the patch will experience one or more of the following side-effects:
Depression, insomnia, anxiety, nervousness, hypersensitivity, numbness/pins and needles (paresthesia), headaches, palpitations, vascular disorders, hypertension, varicose veins, vasodilatation, abdominal pain, diarrhoea, nausea, joint pain, back pain, rashes, breast pain, cervical polyp, endometrial hyperplasia, genital discharge, menstrual cramps (dysmenorrhoea), heavy menstrual bleeding (menorrhagia), menstrual disorders, irregular uterine bleeding (metrorrhagia), weight gain.
Fewer women will experience even more serious side-effects (such as thrombosis and epilepsy). When we multiply all the symptoms by the large numbers of women using HRT, it adds up that a significant number of women are negatively impacted by the use of these products.
When women are being convinced to take medications based on false claims of disease prevention, or even on false promises of how HRT can help with certain symptoms when the science isn’t there, women are being needlessly exposed to multiple risks from HRT.
This violates the central tenet of medical ethics, FIRST, DO NO HARM, and disrupts the principle of informed consent. Medical ethics and medical journalism must, for the good of the public, remain true to these principles.
Who is protecting women from the harm caused by false claims made in the media and on social media?
Until we move beyond this Wild West era, women might best be cautious of anyone who is promoting HRT through fear, and the clear violation of medical ethics.
For women who are concerned with disease prevention, there is good news. Preventing disease does not require exposing ourselves to side-effects from HRT. As I’ve mentioned before in this blog, the research carried out in Blue Zones, areas of the world where populations live long, healthy lives, shows us that healthy lifestyles (low stress, clean diets, gentle movement, uplifting communities) are consistent predictors of long life. The use of HRT has NOT been found to be a predictor.
In addition, we know that healthy lifestyles can have a positive impact on our well-being at any time of life, including during the menopause transition. Feeling better now and in the long-term is much simpler than we think.
References given to supposedly back above-mentioned claims on:
Osteoporosis: Effect of hormone therapy on the risk of bone fractures: a systematic review and meta-analysis of randomized controlled trials - PubMed (nih.gov)
Diabetes: Meta-analysis: effect of hormone-replacement therapy on components of the metabolic syndrome in postmenopausal women - PubMed (nih.gov)
Coronary Heart Disease: Menopausal Hormone Replacement Therapy and Reduction of All-Cause Mortality and Cardiovascular Disease: It’s About Time and Timing - PMC (nih.gov)
Dementia: Frontiers | Systematic review and meta-analysis of the effects of menopause hormone therapy on risk of Alzheimer’s disease and dementia (frontiersin.org)
ARMD: Inverse Association of Female Hormone Replacement Therapy with Age-Related Macular Degeneration and Interactions with ARMS2 Polymorphisms | IOVS | ARVO Journals
Depression: Efficacy of Transdermal Estradiol and Micronized Progesterone in the Prevention of Depressive Symptoms in the Menopause Transition: A Randomized Clinical Trial - PubMed (nih.gov)