The menopause is the new black. Midlife women’s health is suddenly in the spotlight — even royalty joined in, as Sophie, Countess of Wessex, spoke of it being a ‘shackle’ last week — and GPs are under pressure.
The subject went viral the night Davina McCall’s documentary Sex, Myths And The Menopause, a programme I devised and wrote, aired on Channel 4, and the presenter was startlingly honest about her own menopause, admitting she’d been told not to talk about her hot flushes and brain fog as it was ‘a bit unsavoury’. The film revealed that many women were being turned away without medical help, as #davinamenopause trended on Twitter.
Since Davina put on her see-through oestrogen patch on camera, GP surgeries have been bombarded by patients at last recognising their menopause symptoms such as aching joints, hormonal depression and vaginal dryness, and asking for help and hormone replacement therapy (HRT). ‘I’ll have what Davina’s having,’ said patients, according to one GP in Argyll.
Sally Harris, a pharmacist in Wales, tweeted: ‘I dispensed more HRT yesterday than I’d normally do in a month!’
And private health insurer BUPA told me: ‘Since the documentary aired we’ve seen a threefold increase in people booking appointments for our Menopause Plan.’
Davina McCall’s Channel 4 documentary on menopause saw a HRT rush at GPs (stock image)
But what’s been going wrong for so many years with menopause care? Why didn’t women have this knowledge before? And will GPs be equipped to cope with the tsunami of patients? I doubt it — and many GPs seem to agree.
Two days after Davina’s documentary, The Menopause Charity was launched by doctors and patient activists to support women, encourage better access to HRT and help educate medical professionals. Its first action was to offer a free six-hour online menopause course to every GP practice. More than 5,000 of the 9,374 NHS practices in the UK signed up for the training, and more in Ireland — an astounding uptake. It was the sign of a hidden crisis.
Many already overworked GPs and healthcare professionals felt they lacked comprehensive knowledge of the menopause and were willing to catch up in their spare time.
In fact, as I found, menopause training can be almost non-existent. No wonder women have been left to keep calm and carry on.
Davina McCall admitted she felt ‘all washed up’ after going through the menopause as viewers lauded her Channel 4 documentary – Sex, Myths And The Menopause
Yet there are 13 million menopausal women in the UK and, so far, two million people have seen the programme. Clearly it has hit a nerve. The documentary was born out of my own experience, after my hormones went off a cliff and I struggled to get help.
The menopause is bad enough but I didn’t realise its stealthy little sister, the perimenopause, is equally debilitating. Many women in their 40s have no idea fluctuating hormones are affecting their physical and mental health, since they are still getting periods.
Kate Muir who devised and wrote Davina McCall’s documentary; Sex, Myths And The Menopause, aired on Channel 4
In my late 40s, I began getting heart palpitations at night, and high anxiety. My GP sent me for an electrocardiogram at some expense to the NHS. I’m a runner. My heart was fine. ‘Too much coffee,’ was the diagnosis.
Since researching for the documentary and a forthcoming book, I now know 11 per cent of perimenopausal and menopausal women get harmless heart palpitations, which are caused by a fall in the hormone oestrogen.
But my GP didn’t know that, because menopause is not a compulsory module in medical education. A survey by the non-profit group Menopause Support found 41 per cent of UK medical schools do not have mandatory menopause training on the curriculum. After all, only half the planet gets the menopause. A recent survey of 5,000 women revealed that 18 per cent of menopausal women visited their doctor more than six times before getting help.
‘Many women are turned away by their doctor, denied treatment for symptoms not recognised as connected to menopause and incorrectly offered antidepressants rather than first-line treatment, which is HRT,’ says Diane Danzebrink, a psychotherapist and founder of Menopause Support.
She is calling for mandatory GP education in the #MakeMenopauseMatter petition, which has nearly reached its 150,000 target.
But there are no plans at the top for improvement yet.
The Menopause Charity offered a free menopause course to every GP practice (stock image)
Dr Anne Connolly, a GP and clinical champion for women’s health for the Royal College of GPs (RCGP), said: ‘Introducing additional mandatory training courses for some areas of medicine and not others would be unworkable.’ She added: ‘Menopause is included in the RCGP curriculum which all GP trainees need to demonstrate competency of . . .’
Yet look up GPs’ core curriculum and you find menopause in ‘Breast and Gynaecology’, under ‘Other’. It doesn’t even rate a module in the ‘Life Stages’ section which includes ‘Maternity’ and ‘Older Adults’.
Doctors are not to blame in these tough times, as they return to face-to-face consultations after working by phone and video in lockdown, and are given only ten minutes per patient.
But multi-tasking midlife women have suffered collateral damage from Covid — 47 per cent said the pandemic had made the emotional symptoms of menopause worse, according to a survey of more than 2,000 women published last week by the private clinic My Menopause Centre.
Astonishingly, 16 per cent of women aged 45 to 64 are on antidepressants. It doesn’t help that GP practices get an extra ‘quality outcome’ payment from the NHS each time they diagnose depression (or conditions such as high blood pressure), but are paid nothing for diagnosing menopause and prescribing HRT.
Why does this matter? Sixty six per cent of women complaining of low mood were offered anti-depressants by their doctors instead of hormones, despite NHS guidelines to the contrary, according to a Newson Health survey of 3,000 British women.
Sixty six per cent of women complaining of low mood were offered anti-depressants by their doctors instead of hormones (stock image)
A fifty-something viewer messaged me on Instagram after the documentary and said suddenly realising she had been misdiagnosed ‘made me sit there sobbing’. She continued: ‘Eighteen months ago, I gathered the courage to go to my GP with menopause symptoms. I walked out five minutes later with antidepressants. I have struggled every day (and night) since, feeling like I’m going mad . . . today I fixed another appointment and this time I’m going prepared.’
You can track the growing need for help in online sales of herbal and other menopause remedies at Boots — up by more than 60 per cent last year, as women tried to self-medicate in lockdown.
When I was trying to avoid going on HRT, put off by lurid (and, I now know, exaggerated) headlines saying it hugely increased the risk of breast cancer (in fact, the risk from combined HRT is very small and drops once you stop taking it), I tried remedies from black cohosh to soy isoflavones but nothing changed my night sweats, hot flushes, palpitations and creeping memory loss.
Like an estimated 40 per cent of menopausal women, I was experiencing brain fog. My mother was living with Alzheimer’s at the time and I thought I was inheriting the disease. I remember being in her flat and thinking ‘I must shave my legs’ but, writing the shopping list, I couldn’t remember the word ‘razor’.
I was a newspaper film critic then, and my job entailed having a memory bank of 350 movies watched a year, so forgetting a supporting actor’s name was fine. But I’d forgotten an ordinary noun, and that was terrifying.
The good news is that when I went on HRT — oestrogen delivered via a patch or gel, and oral progesterone, which are available on the NHS, plus testosterone gel (which you can only get privately) — my memory came zinging back and my palpitations disappeared along with the hot flushes. I was back to normal.
But how many women are left terrified and alone, thinking they are going mad? Do many GPs know about the latest research on oestrogen’s protective effect on the female brain, and testosterone’s enhancement of female memory, energy and libido? For, yes, testosterone is a female hormone, too. Women make more testosterone than oestrogen, just about a tenth of the amount of men. But the NHS does not offer replacement testosterone to women, except in special circumstances.
It’s not easy for patients to get the facts. The NHS information on the menopause is less than helpful. Put ‘HRT’ into the NHS search engine and this appears: ‘Find out about hormone replacement therapy . . .what the main risks and side-effects are — including how it can raise your risk of breast cancer.’
Many GPs felt they lacked comprehensive knowledge of the menopause (stock image)
It advises that: ‘Some types of HRT can slightly increase the risk of breast cancer and blood clots in some women.’ So little useful information. No wonder women give up.
Dr Heather Currie, a gynaecologist at NHS Dumfries and Galloway and co-editor of the British Medical Society journal, says that on the contrary: ‘The risks of any HRT are very low, and data shows transdermal [gel or patch] HRT is even safer.’
But women and GPs are still put off by breast cancer scare headlines written 20 years ago, prompted by the U.S. Women’s Health Initiative, which has now been criticised as flawed. In that study, older forms of HRT were given to women up to age 79.
The International and British Menopause societies have studied the effects of HRT and are clear the benefits for most women outweigh any risks, especially the newer forms. HRT taken through the skin in patches or gels also has powerful long-term health benefits, protecting women from heart disease, type 2 diabetes and osteoporosis — which eventually affects one woman in two.
Doctors can do further training with the British Menopause Society but the two-day course costs £400 plus accommodation, followed by months shadowing a menopause expert, usually for half a day a week, which may be free or cost thousands in fees. And there are few training places. I met a GP in Birmingham who had waited three years.
But Covid-19 has changed that. Sarah Moger, chief executive of the British Menopause Society, says: ‘We have plans to improve the system and bring more training online to make it easier for healthcare professionals.’
Over at the RCGP, Dr Connolly says: ‘We understand the strength of feeling among women going through menopause, particularly those who don’t feel they have been taken seriously, and that needs to be addressed.’
There is a lot of promising and planning. But women deserve action immediately.
While everyone has good intentions, I can’t help feeling that nothing happens quickly in these medical bureaucracies. The Menopause Charity, which I’m involved in, took just two days to sign up half the country’s GP practices to more training.
Dr Gregory Monk, a recently qualified GP in the Wirral, can’t recall having any specific lectures on menopause at medical school — he has recently taken our course. ‘It offered all the info you need — and it’s practical.’
As well as calling for every surgery to give a menopause symptoms checklist to women in their 40s and 50s, the charity has downloadable PDFs on how to talk to your GP, different kinds of HRT and alternative treatments.
And, as Dr Monk points out, menopause is a matter for everyone. ‘It shouldn’t matter whether your doctor is a man or a woman,’ he says. ‘All GPs should have a good understanding of this so we can help all the women who are suffering at the moment.’ His final advice to women is this: ‘Keep knocking at the door!’
- Everything You Need To Know About the Menopause (But Were Too Afraid To Ask) by Kate Muir, Simon & Schuster, is out in January.