How much has changed in menopause care over the last 50 years?
Medical writer, Sheona Khan delves into the archives and takes a light-hearted look back at how much progress has been made over the last 50 years when it comes to helping women with their experience of menopause.
With the upcoming NHMS webinar on 6th July marking 20 years on from the Women’s Health Initiative study and the resulting negative impact on women’s wellbeing and health, it prompts the question, what was it like to go through the menopause before all this fear around HRT existed? Was the landscape for women actually better than it is today?
An article in You magazine, published by the British Medical Association in 1971 makes for very interesting reading and provides some answers to these questions. In their article ‘Does it have to be blood, sweat and tears?’ – and yes, I am kicking myself I’ve never thought of that title before – Joan Webb investigates the ‘mystery behind the menopause’ and Margaret Clare talks to two women who’ve gone through it.
You can see the full article here and it’s worth a read – even for the gems such as one woman thinking only widows and nuns suffer with the menopause because having a husband means you have a ‘sound constitution and a sunny nature’ and therefore ‘manage better.’ And the woman that was too tired to put her corset on let alone face the world.
Aside from the striking reminders that this article was written more than half a century ago, there are plenty of parallels to be found with today’s menopause climate and what we hear from women on a regular basis.
The article begins with asking whether healthcare professionals are doing enough to support menopausal women beyond the ‘fairly standard pills to adjust hormone balance’ and a friendly word if you’re lucky. Little did the authors know that 30 years later, the ‘standard pills’ would become very much the exception and not the rule and that the change in practice and negative attitudes towards HRT would last for decades.
Webb highlights that women were not prepared for the severity and range of menopausal symptoms when they occur:
“Ask any woman who has experienced “the change” if it happened the way she expected from prior knowledge and available information, and she will probably admit to being surprised by her own bodily reactions.”
With today’s wealth of digital information and ease of access to it, do we now have a generation that understands what half the population will experience and the range of possible symptoms that might arise? Or have we only come so far when it comes to preparing people for the perimenopause and menopause?
One commonality that stood out was stressing the hidden symptoms – the psychological and emotional effects of the menopause – as often the most troubling for women.
“Perhaps the worst part of any women’s menopausal pattern is the “hidden” symptoms – tension, irritability, and emotional instability. With the hormonal changes taking place in her body, it is just as likely that the emotional upheaval is also a natural part of the change.”
Many women were trying to forge ahead in the workplace in the 1970’s but for those that had more severe symptoms and a busy career, giving up their job became a reality if it involved, in their example, press conferences and ‘top level talks’. We know from surveys carried out by Newson Health Research and Education that this is sadly still the case for 12% of working women in the UK today.
If focussing on these similarities between the 1970s and today is diminishing your confidence and optimism in current menopause care, fear not. This article shows very clearly that knowledge about HRT prescribing and the benefits and risks has come a long way. Researcher Mr Ronald Mcdonald (yes, really) studied the effects of estrogen replacement therapy but concluded that although estrogen induced a sense of wellbeing and relieved unpleasant symptoms, the benefits were not convincing when weighed up against the known risks. Isn’t that outcome a tale as old as time when it comes to researching women’s health?
And while the authors recognised that health risks increase after the menopause due to estrogen’s protective effects on the body, the benefits of hormone therapy on future health were not appreciated:
“Oestrogen acts as a preventative against illnesses such as angina and coronary thrombosis. In the years following the menopause, women become naturally more at risk from these diseases, whether oestrogen therapy is used or not.”
One of the arguments against hormone replacement therapy was also the belief that its use required regular and precise measurement of hormone levels that is both ‘complicated and expensive’. With today’s consensus around symptoms-based management and annual reviews once settled on a treatment regime for non-complex cases, HRT prescribing is not the headache it appears to have once been for clinicians.
“Almost the best a woman can expect at the moment is to be told to keep a stiff upper lip when her breasts are beginning to sag and her vagina is starting to shrink….For most of them it is a pretty miserable time in their lives.”
Most of you will hope that your patients experience supportive, empowering, evidence-based care and, judging by this article, that certainly is a significant improvement on what the women of the 1970’s were enduring.