The algorithm is trying to tell me something. As a woman in her forties with a Facebook account, I am, it seems, the perfect target for adverts selling “cures” for perimenopause and menopause. Endless diets (some consisting solely of revolting-looking green liquids); solutions for bloating; energy support supplements; products that offer “perks beyond menopause support” and “promote inner zen”. There’s something called the Balance Tonic (disappointingly without gin). Soothing American tones croon, “You’ll thank yourself for starting this programme for women in menopause,” while encouraging me to embark on a 28-day wall Pilates course.
The menopause industry is – according to an episode of the BBC’s Panorama, “The Menopause Industry Uncovered”, which aired on 30 September – worth billions globally. Over the past five years, there has been huge growth in remedies that promise to do away with debilitating symptoms: anxiety, brain fog, night sweats, hot flushes, and extreme fatigue. But as its presenter Kirsty Wark asked, “What is the science behind the claims being made?”
Not much, it seems. None of the companies selling such products (Panorama looked at 15) are breaking any rules by overpromising with their remedies. But Oxford University’s Centre for Evidence-Based Medicine said little of substance backing-up the claims being made.
Menopause has gone from being underdiscussed to being talked about constantly. As a woman, I welcome the raised awareness of something that will impact me (and possibly has begun to already). But amid this influx of opinion, it is not always easy to identify accurate or helpful information. Most women of a certain age would be forgiven for thinking – thanks to interventions from celebrities such as Lorraine Kelly, Mariella Frostrup and Gwyneth Paltrow – they should rush to get a prescription for hormone replacement therapy (HRT) at the very first signs of sweating.
Dr Sue Mann, the first NHS national clinical director for women’s health, has said that while HRT can be “brilliant” at helping with physical symptoms, it should be seen as “one of a raft of options”, with women informed about its risks and benefits. Yet between 2021-22 and 2022-23, NHS prescriptions for HRT rose by 47 per cent, with 820,000 more women gaining such prescriptions in the space of two years. There is little reliable long-term data on the use of HRT, nor on alternative management options. Just as with other aspects of women’s reproductive health, such as contraception, fertility and birth, it seems they are not getting enough information to make the best choices about their own care. Is menopause an issue requiring treatment, or are we over-medicalising a natural part of a woman’s life cycle?
The media nudges us towards believing medical intervention is the only way forward. When a new, non-hormonal drug was approved in the UK last December, it was reported as a “game-changer”. Yet while the trial data was impressive – the drug reduced the frequency of hot flushes by about 60 per cent – there was also a significant improvement (a 45 per cent reduction) among those who received a placebo. This is not to say medical interventions aren’t best for some, but we don’t always get the full story.
Panorama focuses on Newson Health, the private practice of Dr Louise Newson, who – most notably in documentaries fronted by Davina McCall – extols the virtues of HRT. In the UK, the highest licensed dose of oestrogen is 100 micrograms (mcg) per day. Of the 15 women Panorama spoke to, 13 said they had been on higher doses of HRT through Newson Health. Some were prescribed three times that amount: 300mcg daily – a dose that Janice Rymer, consultant gynaecologist at Guy’s and St Thomas’ NHS Foundation Trust and chair of the British Menopause Society, told the BBC she had “never, ever prescribed”.
Several women told Panorama that Newson Health continued to up their dose of oestrogen when their symptoms, including heavy bleeding and pelvic pain, worsened. Some said they weren’t told that the safety of taking these higher doses hadn’t been established. Newson told the BBC that there is no evidence to link higher doses of oestrogen to an increased risk of long-term harm, and that harm was more likely to be caused by failing to give women the doses they need. A statement on the Newson Health website explains its approach, saying: “Evidence-based medicine is based not only on clinical trial data but also a clinician’s experience and expertise individualised to a patient’s values and preferences. Newson Health clinicians use both individual clinical expertise and the best available external evidence, and neither alone is enough. Absence of evidence does not mean proof of harm.” This is true. But equally, it does not mean proof of safety. The Care Quality Commission has said that it is looking at “information of concern” it has received regarding high doses of HRT prescribed in Newson’s clinics.
Newson Health is right when it says that “menopause care and women’s health… are undervalued, underfunded and under-researched”. Women should not have to endure debilitating symptoms without help. But as Wark said, “What all women deserve is evidence-based treatment and the best possible… care.” It is not at all clear that this means medical interventions, at ever-higher doses, as a go-to solution.
[See also: The trauma ward]
