Kathy Abernethy, menopause specialist, former Chair of the British Menopause Society and Peppy’s Director of Menopause Services, talks about the myths that every woman (and man!) should know about.
As a subject, menopause is ignored, rarely discussed, and often misunderstood.
Yet it is a reality experienced by millions of women. These women should be able to rely on informed, safe and reliable treatment. Yet the web is jammed with inaccurate and misleading content that disempowers women who would otherwise be able to take more control of their health.
Here, Kathy Abernathy, menopause specialist, former Chair of the British Menopause Society and Director of Peppy Menopause Services, busts some common myths.
None of this is personal opinion. All of Kathy’s comments are aligned with current NHS guidelines and the latest research approved by the British Menopause Society.
Myth: Menopause only happens to women over 50
Truth: It doesn’t.
Kathy says: “One in 100 women go through the menopause under the age of 40, and one in 1,000 under the age of 30, and this comes as a shock to women.
“The official terminology when it happens under 40 is ‘Premature Ovarian Insufficiency’ rather than the word ‘menopause’, but that is essentially what it is, and the symptoms can be the same.
“When it happens to a woman in her 30s, it often happens at a time when they have young children, they’re working hard, so they think the tiredness and concentration issues are due to stress and anxiety.”
Kathy says that if a woman goes more than six months without her natural period, and she’s not using contraception, she should seek medical advice. Women who go through the menopause under the age of 40 and do not receive appropriate treatment may suffer long-term health consequences such as osteoporosis and cardiovascular disease.
Myth 2: You need a blood test to diagnose menopause
Truth: You don’t.
“In fact,” Kathy says, “a blood test can be very misleading, especially in women over 45.”
She explains: “Sometimes you can get a misdiagnosis if you get a blood test, rather than a true diagnosis. Blood tests can be appealing to some people, because they see the menopause as a medical condition which is either there or not there, whereas actually female hormones fluctuate widely. Some women think a blood test will give them a clear answer, either ‘yes’ or ‘no’. But it’s just not that simple. Hormones in the blood fluctuate on an almost daily basis.”
Myth: Hormone Replacement Therapy (HRT) is dangerous
Truth: The risks are very small
Kathy says that almost all medication carries some risks. The risk women most worry about with HRT is breast cancer. NICE Guidance confirms that combined HRT (oestrogen and progestogen) can be associated with an increase in the risk of breast cancer, when used long term. The background rate of breast cancer in women aged 50-59 years is 23 per 1000 if HRT Is not used. The extra risk is estimated to be around 5 extra cases per 1000 women using HRT for 7.5 years or more. This is a lesser risk than being overweight or smoking, both of which incur a slight increase risk in breast cancer as does drinking a large glass of wine a day. There is evidence that some HRTs are linked to an even lesser risk than others.
It is unusual to find a woman who won’t benefit from taking a form of HRT if her menopause symptoms require it. “People are concerned about side effects,” she says. “But it’s about personalising the medication. Most women will be able to find a form that suits them. It’s about finding the right dose for the right woman.”
She adds: “Sometimes women come off HRT too early, after just a few weeks, when they haven’t yet experienced the benefits. Women shouldn’t be scared of taking HRT if their menopause symptoms are bothersome and affecting their day-to-day lives.”
Myth: HRT simply postpones the menopause
Truth: That’s not how it works
Kathy has seen many patients who believed that if they took HRT, they would just be putting off the inevitable and they would have to experience the menopause at some point afterwards.
She says: “The way HRT works is to override the menopause. The menopause continues in the background, but you’re not aware of it because the HRT is making you feel good and well.
“Sometimes women think HRT is more of a delaying medication. And when women talk about coming off HRT and then experiencing menopause symptoms, what’s actually happening is their symptoms are lasting a long time, and they’re just not taking HRT for long enough.”
Myth: You can’t start HRT until your periods have stopped
Truth: You can
For some women, the worst menopausal symptoms are in the run up to periods stopping, so that could be the very time those women need HRT the most.
“The HRT can help women over a much longer period of time,” says Kathy.
“Sometimes doctors tell women that they can’t go on HRT until they’re ‘in’ menopause. Women are told to wait until their periods stop, and ‘then we’ll know what’s happening’. But they could benefit a great deal from taking HRT for a longer time.”
Myth: HRT either suits you or it doesn’t
Truth: It just needs to be more personalised
Kathy comments: “People think there’s just one form of HRT, but there are lots of different types, doses, and ways of taking it. Every woman can try a different personalised way of taking HRT, whether it’s in the form of a tablet or a patch or a gel. There are also a lot of different doses, and a lot of different types.
Prescribing HRT just needs to be bespoke for each individual woman.