Menopause myths. We separate truth from fiction.
Written by Hormone Health Associate
Dr Justine Setchell Consultant in women’s health and the menopause.
It is heartening to see so much information out there about the menopause these days, and to see taboos and barriers being broken down. But it is still frightening how many untruths persist. As a GP with a long-standing interest in Menopause as well as women’s wellness, I would like to set the record straight. I am in the privileged position of working as a GP in a private menopause clinic, but I am very much aware that this service is only accessible to a small minority of women. It is important that evidence-based, sensible menopause advice is available to everybody.
So, let us look at some of the most common myths around Menopause:
Myth 1: Menopause is something that happens in your late forties/early fifties.
The average age of the Menopause is indeed 51, but an early menopause is defined as starting between the ages of 40-45. Women under the age of 40 and going through symptoms of menopause, are known to be experiencing premature menopause.
It breaks my heart the number of times I have seen younger patients, who have been backwards and forwards to rheumatologists (aching joints) cardiologists (palpitations) urologists (recurrent urinary tract infections) or psychiatrists (anxiety/depression) without anyone thinking to join up the dots. Taking the time to ask her about her menstrual cycle or family history of early menopause. Not all women present with classic menopause symptoms of hot flushes/sweats. I feel that premature menopause should be part of all of my specialist colleague’s differential diagnosis.
Myth 2: I’m too young for HRT/it’s too risky.
HRT in women under 51 is a very different prospect to HRT in women over 51. In younger women, they are quite literally replacing the hormones they were “entitled to” and would have had if they hadn’t experienced an early menopause transition. So, the same HRT risk profile does not always apply. Hormone replacement, as well as resolving symptoms, is essential to prevent premature bone loss, adverse cardiovascular effects and possibly early adverse effects on the brain.
Myth 3: HRT will cause weight gain.
In my experience, this is quite the opposite, as long as lifestyle factors are also addressed. I am often asked how to lose weight during menopause or keep on top of weight gain. The truth is that lower levels of oestrogen are associated with insulin resistance so I am afraid that simple/processed carbohydrates are the menopausal woman’s enemy. We just don’t metabolise carbohydrates as well which results in central weight gain (that stubborn bit in the middle!) A low carbohydrate approach along with daily activity (aim for at least 10,000 steps a day) and optimisation of hormone levels usually works well.
Myth 4: I won’t be able to keep my bladder under control
I’m glad that urinary incontinence is now talked about more openly but frustrated that it is often thought of as an inevitable part of the menopause transition. Women’s entire uro-genital area is affected by the menopausal drop in oestrogen levels so urinary symptoms are quite common but so often easy to resolve with the use of low dose topical oestrogen. Pure stress incontinence (often associated with prolapse) is a whole different ball game but before patients go down the urology investigation line for urgency symptoms or recurrent infections, it’s often worth at least trying some topical oestrogen first.
Myth 5: Testosterone will make me hairy!
Patients do sometimes experience a little additional hair growth at the site of application, so I just tell them to apply to the very low abdomen. Testosterone is often overlooked, and in some patients, replacement makes all the difference to the management of their menopause symptoms. Patients describe a “tsunami’ of tiredness where they would happily lie on the floor as their family walked over them. I find that even a small dose of testosterone in these patients can make all the difference in getting through the day. Sadly, many NHS GP’s are reluctant to prescribe but do persevere! Testosterone replacement is included in the NICE guidelines.
Menopause symptoms can wreak havoc on women’s bodies, having a real impact on day-to-day life, so women should gather as much information as possible on the help and treatments that are available to them. We could certainly write part two (or three!) to this but for now, if you would like more information or ammunition with which to approach your doctor, the following resources are invaluable:
If you would like any advice, or to discuss your health needs, please contact Dr Justine Setchell at Hormone Health 92 Harley Street Clinic.
Dr Justine Setchell has been a GP for 21 years, latterly within the private sector. She trained at Imperial College Medical school. In addition to holding her Certificate in Menopause Management, she is a member of The British Menopause Society and a Diplomate of the Royal College of Obstetrics & Gynaecology.