Menopause is surrounded by unhealthy misinformation – The Sydney Morning Herald

There comes a time in every woman's life (for argument's sake, let's say it's around 48) that she can no longer ignore the elephant in the room. Andso during a recent visit to a women's health clinic I finally broached the menopause talk.

When I mentioned hormone replacement therapy (HRT, the medical replacement of a woman's oestrogen and progesterone and, sometimes, testosterone) the nurse's eyebrows almost took flight.

"HRT can really help manage the symptoms of menopause and it's safe," she added a little too quickly.

She went on to tell me that few women my age enquired about HRT. She suspected that they simply didn't trust it.

This didn't come as a complete surprise. I'd recently read that since the early 2000s, the number of women taking HRT had fallen by more than 60 per cent. This downward trend was reflected in women I know: of the 10 menopausal and post-menopausal women I spoke with for this article, only two had chosen HRT.

Several told me that their symptoms weren't severe or long-lasting enough to warrant intervention, others had looked at alternative medicine, but a few were still, some years down the track, suffering from anxietyand those interminable hot flashes and night sweats.

The reasons they dismissed HRT were simple they believed it dangerous and perhaps, even, deadly. Now this was a serious indictment for a treatment once billed as the cure-all of menopausal symptoms, as well as osteoporosis and heart disease, so the question had to be asked why?

To get some perspective we need to go back to 2002 when the Women's Health Initiative (WHI) released its longitudinal study, conducted to address health issues causing disease and early deaths in post-menopausal women. While ambivalent about cardiovascular benefits, the study concluded that taking HRT significantly increased the chance of breast cancer.

Few words carry more emotional weight for women than breast cancer (something the media were quick to pick up on), so it was little surprise that women abandoned HRT en masse.But unknown to many (including, it has to be said, many in the medical profession), the report, which was prematurely terminated, was riddled with inconsistencies.

Writing in Science Daily last month, International Menopause Society scientist and one of WHI's principal investigators Professor R. D. Langerwrote: "The incendiary reports indicated that the study was stopped because HRT caused breast cancer and heart attacks, when in reality there was no statistically significant harm for either breast cancer or heart attacks."

Endocrinologist and medical director of WA's Keogh Institute for Medical Professor Bronwyn Stuckey tells me that another problem with the 2002 report was that the results were said to apply to women of all ages, a finding rectified by a subsequent WHI 2007 report which acknowledged "that there was an age at which it's safe to start [HRT] and an age at which you probably should have second thoughts about starting".

The 2007 WHI report righted a series of wrongs, says Stuckey. It revealed that an early uptake of HRT increased protection against cardiovascular disease and led to a drop in type 2 diabetes, but most surprisingly and significantly it showed that there was less breast cancer among menopausal women solely on oestrogen than those on the placebo.

"It also showed that women who stopped taking HRT after five years had the same incidence of breast cancer as women who'd never taken it," says Stuckey.

Surely there was enough here to alleviate the fears of a significant number of women, so why wasn't this better known? Stuckey has her theories.

"It comes down to GPs being scared of it because they've grown up in the WHI era and it's a big problem," she says. "There's also something else at play, too. When you turn 50, the government invites you to have a mammogram, but it would be much more appropriate if women were invited to have their cholesterol checked, because heart disease is a much bigger killer of menopausal women than breast cancer is."

So there it was. This to me seemed the bigger scandal here. The fact that we weren't being given the proper information went beyond sheer negligence and moved into a far less grey area of potentially failing to save lives.

With the current consensus being that the earlier a menopausal woman starts on HRT the better, I know which road I'll be taking. Basically, like any working mother I've got enough worries to lose sleep over, but I'll not allow menopause to be one of them.

Jen Vuk is a freelance writer.

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Menopause is surrounded by unhealthy misinformation - The Sydney Morning Herald