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It’s great that more women are asking me for HRT, but it’s not a one size fits all treatment

The i 17/05/2022 Heather Saul

At long last, we are talking openly about a phase of life that affects all women: the menopause.

I recall watching my grandmother and mum suffer in silence as they transitioned through their menopause journeys years ago. During my medical training, menopause was only briefly mentioned, and so I still didn’t know how to support my mum even though I was soon to be a doctor. I still feel guilty that I didn’t understand the depths to which her symptoms affected her. In my Indian culture, menopause carries even more taboo, and women are expected to “just get on with it”.

Thankfully, however, recent widespread coverage coupled with the incredible efforts of women campaigning to raise awareness of the menopause has meant many women feel more confident talking about their symptoms and asking for help.

I started medical school in 2001 and since then I’ve seen a change in attitude, both within the academic sphere and the public domain.

Menopause has gone from being a small segment in our curriculum over a decade ago to becoming a comprehensive part of both undergraduate and postgraduate medical education. It gives me joy to teach the next generation of medics about the physiology of menopause and learn more myself.

Our poor understanding of women’s health due to lack of dedicated research and funding has meant much harm has come from the misinformation around hormone replacement therapy (HRT).

During menopause, as vital female hormones alter and oestrogen levels drop, every single cell within that woman’s body undergoes a dramatic change. The physical, mental and emotional impacts of such hormonal shifts mean many women find their lives turned upside down.

Hormonal replacement therapies can help women continue managing their daily lives, work and social interactions, but due to fear-mongering and misinformation around HRT, women turned away from it and many suffered as a result.

Throughout my career as a GP, I have been astounded by how few women have come forward to talk about their menopause symptoms. But over the last few months, I’ve seen a real surge in the number of women booking appointments to discuss their menopause symptoms and actively asking for HRT. It’s wonderful to be part of these consultations where women have taken ownership of their health, done their research and come in to have a consultation about whether HRT is right for them. It’s exciting to see the ripple effect of the great work being done by those campaigning.

The focus recently has very much been on raising awareness about HRT itself. While this is welcome, it’s important that women know they have lots of treatment options available to them.

Menopause is very complex and no two women will experience exactly the same symptoms or issues. This means time needs to be taken to explore what the menopause means for that particular woman – that starts with a chat with the GP.

I recently had a patient who was peri-menopausal (the transitional phase before menopause, which is when the periods completely stop). She had put off seeking help for months, but after watching a programme on menopause, she came in to see me.

My patient wasn’t sure about HRT but wanted to discuss her options. For her to make an informed decision, she needed to know all the facts. She felt HRT wasn’t right for her at this stage as her symptoms were mild and she also wanted to try other options first. We spoke about lifestyle factors that could help for now and planned to revisit the situation when she felt she needed some extra support or treatment.

It’s really important to take a holistic approach to managing menopause. It’s not a medical condition as such, but if managed poorly from the outset, it can go on to create problems such as mood disorders, urinary tract infections, fatigue, brain fog, and relationship issues, to name just a few.

Things GPs will need to consider include: how the main symptoms are affecting their patient, what her lifestyle is like, her past medical history, what other medications she is on, and what her risk/benefit profile is. Patients need to be given the space and time to set out to their GP how they are being affected.

Whilst HRT should be considered as a first-line therapy option, some women do not wish to go on it. Raising awareness of all the other management options empowers all women. These include lifestyle factors, non-hormonal therapies such as clonidine or SSRIs which are a type of anti-depressant, alternative medicines as well as yoga and acupuncture. Talking therapies like cognitive behavioural therapy (CBT) are powerful interventions if symptoms are having psychological impacts. The more we normalise these options, the better the journey for all.

I’m really pleased with the way conversations are opening up. As a primary care physician, I encourage all women to become experts in their own health and well-being journeys and reach out for help when they feel something isn’t quite right.

Dr Punam Krishan is an NHS GP in Glasgow, medical educator and director of the British Society of Lifestyle Medicine


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