Menopause myths

Despite Menopause having a major moment in the spotlight in recent years: moving it from the shadows of a poorly understood & poorly underfunded global health issue to a word that is hard at times to avoid, there remains a lot of misconception and myth that can often lead to confusion, vulnerability, unnecessary anxiety, and decision paralysis.  

I firmly believe that this stage of life can be an affirming, empowering and positive once we have accurate evidence-based information and support with which to make decisions about our health and wellbeing. So, with that in mind I want to debunk some of the most common menopause myths doing the rounds.

1. There is no such thing as Too Young:

Premature Ovarian Insufficiency (POI) is often unexplained and sudden in onset and estimated to affect 1 in 100 women under 40
1 in 1000 women under 30.

Surgical and medical menopause can occur at any age and which despite being easy to predict is still not always managed effectively enough leading to horrendous consequences for thousands of women.

For these women, an effective Hormone Replacement Therapy (HRT) regime is imperative (until at least average age of natural menopause) in order to reduce the risk of premature cardiovascular, metabolic and bone disease that is common when sex-hormone levels are low.

And here is some simple maths: average onset of menopause is between 45-55. Perimenopause may start up to 15yrs prior to menopause and so Perimenopause may start “naturally” from as young as 30.

I hope this also debunks the myth that “menopause only affects older women”

Proactively addressing lifestyle elements is helpful for hormone and general health at every age and personalised, proactive medical intervention may provide important prevention as well as symptom-relief.
2. There is no such thing as “too old” for proactive menopause care

Many women who I see in clinic have been told they are “too old” to start or continue their hormone therapy. Let’s get this straight – there are no blanket upper limits or age cut-offs for safe hormone therapy use. This is plain ageism. The current British Menopause Society (BMS) advice recommends that ongoing treatment with hormone therapy is appropriate if on individualised assessment of all factors the benefits of treatment outweigh risk. And for most women who start hormone therapy within 10yrs of their final period the benefits will likely outweigh risk.

That said, our breast cancer risk and cardiovascular risk increases naturally as we age and being on combined HRT may increase this risk further. Starting hormone therapy more than 10yrs after final period may increase risk of stroke but this still does not mean it cannot be considered on an individual basis. Ultimately it is imperative to make informed and collaborative decisions based on individual risk and benefits.

Many women will stop hormone therapy if their risk of breast disease is high or indeed if they develop a medical problem that means hormone therapy is no longer safe.

It is also important to note that localised use of oestrogen intravaginally is very safe for long-term use and I regularly recommend this to older women particularly for symptoms of dryness, discomfort, bladder sensitivity, cystitis or UTI.

And again, proactive, and holistic support in managing lifestyle factors is appropriate irrespective of age (or indeed gender).

3. Menopause is a Natural Process and seeking medical support is “failing” or unnatural.

Yes, menopause and perimenopause are natural and processes for most women but as mentioned above some medical problems, medical treatments and operations cause this to happen early – which is far from natural. Just because something is natural does not mean it should not be proactively or medically managed. Menopause involves dramatic neuroendocrine transition that impacts every single system in our bodies. The impact will vary from person to person and there is no easy way to predict how you will feel – and equally no blame to be laid. Suffering is not necessary and seeking medical support is not failing or a sign of weakness. And remember, “supplements” are un-regulated medicines so over-relying on these is not “natural” and not necessarily known to be safe.

4. If you are having periods it is not menopause.

Well strictly this statement is true because the definition of menopause is the point at which you have not had a natural period for 12 months. However, most women will start to experience symptoms of low oestrogen and testosterone whilst still ovulating and having periods in perimenopause.

5. HRT is a silver bullet and everyone should use it.

HRT is the most effective medical intervention for treating the underlying physiological changes we see in perimenopause, menopause and beyond. It is also the most well-studied with the most evidence of safety. However, it does not work for everybody. Many women are intolerant to synthetic hormones or very sensitive to the more natural “body identical” types. For many women it is not safe and alternative pharmacological and lifestyle strategies are required.

6. You cannot use HRT if you have migraine, liver problems, heart disease or blood clots.

Using oestrogen via the skin in appropriate dosing is safe for many women who have previously been advised that they “cannot” or “must not” use oestrogen. The risk here is when oral oestrogen is used as this increases the risk of blood clots forming. However, when given via the skin the risk of blood clots is minimised. In fact, menstrual migraine often gets much worse in perimenopause and providing hormone therapy to help reduce the impact of big hormone fluctuations can stabilise and reduce migraine frequency.

7. You cannot use HRT if you have a strong family history of cancer or a cancer diagnosis.

A previous cancer diagnosis or family history does not automatically mean HRT is not safe. If there is a strong family history of breast cancer, then risk assessments and genetic testing can be useful to define risk and inform decision-making. We also need to take care with personal or family history of ovarian or womb cancers. However, there is some new evidence to indicate HRT may have a protective impact on bowel cancer risk. But more research is needed. It is important to remember that even if HRT presents an increased risk, there are many other options too.

8. You cannot fall pregnant on HRT or in perimenopause

This is important. If you are still ovulating (even erratically) there is still a risk of pregnancy and hormone therapy is not strong enough to suppress ovulation so does not provide contraception like the hormonal pill does. So it is important to ensure adequate contraception alongside menopause management. Indeed, even with a diagnosis of POI there is a small risk of spontaneous pregnancy and contraception needs to be considered if not trying to conceive.

Mirena coil can be particularly useful as it provides progesterone locally into the womb and has the triple effect of providing contraception, reduces or stops menstrual bleeding and can be a localised way to deliver the progesterone element of hormone therapy (to protect the womb-lining).

9. “It is all in your head”

If this myth is used to undermine, belittle and shame women then it sure if effective. With such a wide spread of symptoms and the distress that these can cause, too often women seek advice multiple times about multiple symptoms before the dots are joined and a diagnosis of perimenopause or menopause is made. And sadly too often, women are made to think they are somehow to blame or are making things up. THIS IS NOT THE CASE.

But…here is a curve-ball or a spin to consider: many of the symptoms we experience are neurological in origin i.e. they are a result of insufficient hormonal influence in the brain and nervous system. Sleep, temperature, mood, memory, cognition, confidence and pain are all functions of the nervous system that can be negatively impacted during this phase of neuroendocrine transition.