No, menopause is not a disease and should not be overmedicalized.

2024-03-05 19:51:03
A series of peer-reviewed articles, published in The Lancet, warn against the excessive medicalization of menopause and make a strong call for a new social approach to transform the perception of this natural stage of life that affects the half of the world’s population. Contrary to the traditional narrative that presents menopause as a medical problem to be resolved through hormonal therapies, the authors of this group of articles advocate for a change in the understanding of this biological process as an inherent part of healthy aging for women. Professor Martha Hickey, co-author of the series, highlights the need to “abandon the preconceived and erroneous idea that menopause always leads to a deterioration in physical and mental health.” Related News Standard medicine No Many cancer drugs in Europe do not demonstrate additional benefit Rafael Ibarra More than 50% recover the R&D investment in three years, according to a study published in the British Medical Journal According to Hickey, from the University of Melbourne and the Royal Women’s Hospital (Australia), “many women live rewarding lives during and after menopause, contributing to work, family life and wider society. “Changing the narrative to view menopause as part of healthy aging can better empower women to navigate this stage of life and reduce fear and concern among those who have not yet experienced it.” Menopause, says Carlos Millán, specialist in gynecology and obstetrics at Vithas International, a medical center dependent on the Vithas Madrid Arturo Soria University Hospital, “is not a disease, it is a stage that all women will go through.” And, he emphasizes, it is very important to prepare and inform the woman very well about this stage of her life. The series challenges the oversimplification of menopause as a health issue and seeks to direct attention toward substantial social changes. A review of the evidence on menopause symptoms highlights that hot flashes and/or night sweats affect up to 80% of women, with more than a third (38%) describing these symptoms as moderate to severe by age 50. It is very important to prepare and inform women very well about this stage of their life. The experience of menopause is different for each person, which is why, Hickey points out, an “individualized approach is necessary in which women receive accurate, coherent and impartial to make informed decisions during the menopause transition. This may include menopause hormone replacement therapy (HRT) for symptoms such as hot flashes and night sweats, which can range from mild to extremely debilitating. “Although some women may also opt for psychological therapies, such as cognitive behavioral therapy, to reduce the psychological impact of hot flashes and night sweats and improve sleep.” The articles specifically address the lack of optimal care for particular groups of women, such as those experiencing early or cancer treatment-induced menopause, who often lack adequate support. Globally, about 10% of women experience menopause prematurely (under 40 years) or early (between 40 and 44 years). There are often delays in diagnosis and some women experience feelings of distress and isolation. There is also evidence to suggest that women who enter menopause prematurely or early may have a higher risk of diseases such as cardiovascular disease and osteoporosis (brittle bones). Using HRT can reduce these risks. Early menopause Additionally, people with cancer are more likely to experience early menopause. For example, endocrine therapy for breast cancer can cause hot flashes and/or night sweats that may be more severe and prolonged than natural menopause. Women with cancer often report a lack of centralized care and access to safe and effective treatments. The document also debunks the widespread idea that menopause leads to mental health problems, highlighting the need for a more individualized and precise approach. There is a widespread belief that menopause is associated with poor mental health; However, a review of 12 studies, published as part of this paper, investigating the association between the menopausal transition and depression, does not confirm this. After reviewing these studies and others, this paper concludes that there is no strong evidence that the risk of anxiety, bipolar disorder, psychosis, or suicide increases for all women during the menopause transition. In this regard, Lydia Brown, also co-author of The series and affiliated with the University of Melbourne (Australia), emphasizes that “the change in the narrative is crucial to reduce stigma and overmedicalization, empowering women to approach this phase of life with confidence and comprehensive support.” Spain, still very far away The reality of Spain “is very far from what these studies indicate, says Carlos Millán, specialist in gynecology and obstetrics at Vithas International. «We are far behind the Anglo-Saxon and Nordic countries. In Spain, he explains, there is still a lot of fear about treating women with HRT due to studies from the 80s and 90s that associated the therapy with some types of cancer. This has meant that a large majority of women in our country do not want to treat themselves and, if they do not, they use natural means, treating only the symptoms, such as hot flashes or depression. But not just women, he adds, since many health professionals are reluctant to use HRT. “Within the medical society there is still a certain fear and lack of knowledge about using hormone therapy.” For the expert, it is important to remember that hormonal treatments have changed a lot and, “from the horse hormones that were used years ago, we have moved on to the use of bioidentical hormones.” In contrast to the rejection of HRT, Millán adds, “more than half of women who are in menopause take some sleeping medication or a minor antidepressant, when for many HRT would be enough to control these symptoms.” We can conclude, he adds, that “while in these countries to which the study refers there could be overmedicalization, in Spain we would be undermedicalized.” “We are very far away, but for the worse,” he adds. While Brown acknowledges that some women have extremely negative experiences with menopause and benefit from hormone therapies, that’s not the whole picture. «The reality is much more complex and varied: some women report neutral experiences and others highlight good aspects, such as the absence of menstruation and menstrual pain. “Menopause is experiencing a cultural moment and this is an opportunity for it to be recognized as a natural part of healthy aging for women that, with the right preparation and support, is not something to fear.” The authors emphasize the need for women to have access to accurate, evidence-based information, free of commercial influence. The series recognizes the “menopause moment” that countries such as the United Kingdom, the United States and Australia are experiencing, where there is an increase in public awareness on this issue. However, the authors express concern about the media’s tendency to focus on extreme negative experiences, thus contributing to a biased and stigmatized perception of menopause. Commercial interests, such as pharmaceutical companies and organizations that market menopause products, have also influenced the presentation of media messages, according to this research. Therefore, the authors emphasize the need for women to have access to accurate, evidence-based information, free of commercial influence. The series concludes by calling for greater awareness and understanding towards early menopause, after cancer treatment and the associated mental health risks in this transition and highlights the importance of a holistic approach that allows all women to access balanced information, options effective treatment options and social support that empowers them in this unique stage of life.
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