The UK parliament, which hasn’t exactly been the hub of stellar public health policies in recent years (to say the least), now wants to medically manage your menopause.
What could possibly go wrong?
Set up to "tackle the lack of understanding around menopause amongst policymakers, the public and employers," the All-Party Parliamentary Group on Menopause brings together a small collection of MPs to advise on policy reform. They hope to influence the national menopause discourse and flow of government funds, to determine the type of messaging and support women in the UK will receive as they journey through midlife change.
There are hundreds of All-Party Parliamentary Groups (APPGs). You can see the list here. I went through dozens of them, seeking out what I would imagine are pressing issues for the country, and I only found one group (the All-Party Parliamentary Group on Health) that was better funded (by pharma interests, of course) than the menopause group.
Interestingly, according to the Parliament’s website, the funds for the menopause group came from one pharmaceutical company (that just happens to be developing a new menopause drug). The company had thoughtfully set aside an annual budget of between £64,501-£66,000 to fund the secretariat of the group. By comparison, an All-Party Parliamentary Group on Women’s Health (covering all health issues for women) was funded by five pharmaceutical and medical device companies but their annual funding came to between £45,001-£46,500.
So, with one pharmaceutical interest having a significant influence in the group, and another joining in with an undisclosed amount to help fund the Concluding Report issued by the group in October 2022, is it any surprise that the Report strongly focused on the increasing medicalization of menopause? No, it’s not. This is how parliamentarians and governments are captured and tax money ends up being spent – serving particular interests that are not necessarily the interests of the population.
According to the Report, currently in the UK, approximately 86% of menopausal women aren’t taking HRT. One could assume therefore, that within the population there is a significant interest in non-hormonal routes that can offer menopause symptom relief. Perhaps the APPG’s focus might well be on funding and researching alternative therapies that can help women journey through midlife change – it would seem that’s what many in the population want.
Not so, suggests the report. The report’s authors argue that HRT is under-prescribed because patients and doctors are ill-informed as to the benefits, and because of economic disparity.
I do not doubt that a woman’s economic standing can impact the level of healthcare she receives. And I do not doubt that the medical system often fails to give appropriate care to women. However, for the APPG on menopause, it’s as if decades of scandals around HRT, promises about HRT that were proven false, court cases and settlements that together will have awarded up to $1.2B to women who were diagnosed with cancer linked to just a single HRT product are inconveniences, or as summed up in the Report’s own words: “misreported to the press as a result of misinformation and overgeneralisation of data.”
More than that, it’s as if HRT is a simple drug to prescribe – always hitting the mark. This is not so! If you spend any time talking to menopausal women who have chosen the HRT route, you will hear numerous stories of women who go through trial and error trying to find a form of HRT that suits them – one that doesn’t give them debilitating side-effects, which in turn result in multiple doctors’ visits.
When doctors know that HRT can help a percentage of women but can also cause vaginal bleeding, depression, headaches, bloating and swelling, and more, is it any wonder that they are hesitant about writing out prescriptions? Not to mention that when women have to come off HRT after about seven years (because of the increased risk of side-effects related to long-term use), many of them will experience a return of their symptoms. What should doctors explain to their patients then?
In the UK, as we saw in the 2022 Channel 4 programme “Sex, Mind and the Menopause,” (that I wrote about extensively here), there is a push to encourage women to demand off-label testosterone supplements for menopause symptoms. Where is the science that this is safe? In the Reports own words: “There is some evidence that testosterone is beneficial…” This isn’t science. This is wishful thinking … backed up by “evidence” given to the APPG by, wait for it, a pharmaceutical manufacturer of testosterone products.
Can we perhaps see some non-pharma funded large randomized controlled trials on testosterone products for women before it is widely prescribed off-label? No need to wait, suggests a famous UK menopause doctor to the APPG.
What a brilliant idea! Let’s rush ahead encouraging women to take testosterone products before there are any large randomized controlled trials that have concluded that long term use of testosterone among menopausal women is safe and effective.
Hang on! What does this remind me of? Oh yes, in the 1960s, women were told to take estrogen therapy for life because it was a “wonder drug” that just happened to not have undergone any long-term safety testing. Then in the 1970s, it was a revealed that there was a significant increase in cases of endometrial cancer (a cancer in the lining of the uterus) that arose from women taking estrogen therapy.
“Take estrogen with progestin!” was the response of medicine as women were encouraged to take this new form of combined HRT, that hadn’t undergone any long-term safety testing, either. “That will ease your symptoms and save your uterus!” medicine assured women. But then decades later, it became apparent there was a huge increase in breast cancer cases among women who had taken combined HRT.
Do we have to make the same mistakes again and again and put women’s health at risk for the lure of a quick fix (and an increase in pharma profits)?
Among the Concluding Report’s recommendations are the following points: "The Government must fund and commission more research into:
- the benefits of HRT in different use cases and its long term health benefits;
- the link between menopause and health conditions including dementia, mental health illness such as depression and psychosis, musculoskeletal conditions, cardiovascular conditions and type 2 diabetes."
It seems the authors are determined to ignore history!
In the 1960s and early 1970s, the medical establishment claimed that hormone therapy could treat over 25 symptoms associated with menopause (such as those listed above) and that hormone therapy could offer women long-term health benefits, such as protection against strokes, cancer and cardiovascular disease.
The reason organizations such as the North American Menopause Society and other similar organizations worldwide no longer make these claims is because over the decades all large randomized controlled studies of hormone therapies disproved these promises that were never based on solid science to begin with (as I explain in this blog post and in more detail in my book). Why on earth is a UK parliamentary group trying to push women back into the 1960s and allocate government funding in the process?
The answer can be found in the Report’s definition of menopause:
“Menopause is essentially a hormone deficiency,” the report states.
Okay, in the 1960’s menopause was called a hormone deficiency disease. They’ve dropped the word disease to make it sound nicer but the approach is the same! If menopause is defined as a hormone deficiency, of course the answer must be HRT.
BUT menopause is not a deficiency! Menopause is a natural part of a woman’s life-cycle that is a sensitive time. Certain hormone levels drop because that is what the intelligence of nature intended. Menopause gives women a chance to reclaim parts of their lives that are untended to and under-nourished. We can experience symptoms if our lives are out of balance but the sensitivity is designed to encourage us to bring our lives back into balance – emotionally, physically and spiritually. This will help us embrace good health and well-being as we age. Menopause is a brilliant teacher and it will protect us as we move forward if we learn the lessons it offers.
Rather than a state of deficiency, menopause is a graduation to a position of elder – a wiser woman. Women reach something greater than before – not less than, because a woman who passes through midlife has lower levels of certain hormones.
But there’s more offered by the Report: a pièce de resistance! A true pharma dream!
One of the Report’s recommendations suggests:
“The NHS must implement a health check for all women at the age of 45.”
If this wasn’t embedded in a document that represented an unashamed parliament-led push to increase the number of women on HRT, perhaps we could hope that such health checks could offer women a variety of options to support them through menopause.
In the same bullet point, the recommendation continues:
“The NHS can also do more to prepare women and provide them with information [about menopause] throughout their lives, be it at cervical smears, mammograms, postnatal checks and so on.”
So, you can get a cervical smear and encounter an upsell for HRT? I wonder, is that while your legs are open or closed?
And if you think I’m being cynical, perhaps you have yet to notice how medical staff, especially in recent years, have been incentivized to offer patients extra treatments that they hadn’t intended to receive.
The Report does have a section on alternative treatments and right up front it makes it very clear what the public should think of them:
“The APPG recognises that the evidence on the effectiveness of CBT, complementary and holistic treatments or herbal therapies is unclear and often disputed within the menopause community, and they are unable to treat a wide range of menopause symptoms in the way that HRT can.”
Do you get it now? It doesn’t matter if we don’t have the evidence on the safety of testosterone products for women, for example, because that comes from pharma, but those herbal and holistic treatments that are grounded in health traditions going back hundreds of years if not more, be wary of them!
The Report’s section on alternative treatments is the only section without recommendations (in other words, no government funding needed there!). It is also the only section not mentioned in the Executive Summary. In fact, the highlighted summary within the alternative treatments section strangely brings the focus back to HRT. It discusses how HRT is a postcode lottery, how inferior natural supplements are to HRT, and enters into a discussion revolving around class – point being that if only HRT were cheap or free, almost every woman would surely be on it, and be happy.
It's 2023, and it feels like the UK is going back in time.
So, where is the press on all of this? Towing the cross-party pharma line and pushing HRT all the way.
Do you really trust parliament and their pharma backers to manage your menopause? Unfortunately, currently, they do have taxpayers money to use as they please.
Luckily, however, you can learn from history. And nothing can detract from the fact that you are your own best guide during this fascinating time of change!