Out of Touch on Menopause: Experts Respond to The Lancet's 'Over-Medicalization' Claims

[niyad]

(JFC, Lancet, what the hell happened to you??)


Out of Touch on Menopause: Experts Respond to The Lancet’s ‘Over-Medicalization’ Claims
PUBLISHED 4/15/2024 by Dr. Mary Claire Haver
Women entering the menopausal transition deserve up-to-date science that reflects their lived experience.



Ninety percent of women were never educated about menopause, and over 73 percent do not treat their symptoms because they do not know that they can. (Sergey Mironov / Getty Images)

Menopause is gaining attention in the media and highest levels of government, including the White House—but we still have a long way to go to ensure women get the support they need. A recent series issued by a respected journal, The Lancet, proves this point. The Lancet series claims to promote an “empowerment model for managing menopause.” To us—more than 250 obstetrician-gynecologists, family medicine physicians, cardiologists, internists, urologists, medical oncologists, psychiatrists, orthopedic surgeons, nurse practitioners and licensed therapists—this was an unexpected and welcome opportunity. Our daily work focuses on these same goals. Despite the encouraging headline, the series was awash with misstatements that do not reflect the lived experience of women in this stage of life or our clinical experience in treating them. In several cases, The Lancet authors relied on outdated data to make their case.

Among our rebuttals:

“Most women navigate menopause without the need for medical treatments.”

The more accurate statement would be that most women navigate menopause without being given the option of medical treatments.

Ninety percent of women were never educated about menopause.
Over 73 percent do not treat their symptoms because they do not know that they can.
In the United States, only 7 percent of OB-GYN, internal medicine and family medicine residents felt competent in treating a menopausal woman, although many admitted it was important.

During the menopausal transition, women should “challenge self-critical beliefs, which can … make [hot] flushes worse.”

This tone-deaf suggestion perpetuates the “it’s all in her head” narrative that has been used for decades to dismiss women who present with physical symptoms in the clinical setting. The fact is that hot flushes (flashes), like heart palpitations, are a vasomotor symptom of menopause—a biologic change with known causality due to declining levels of estrogen, disruptions in hypothalamus activity trigger blood vessel dilation and cause a sensation of heat to spread from the chest towards the extremities. These symptoms result from disruptions in the body’s thermoregulatory system and are not psychological in nature.

. . . . .
“Over-medicalization of menopause can lead to disempowerment and over-treatment.”
. . ...

The painful reality for many patients is that clinicians repeatedly fail to recognize their symptoms of menopause that extend beyond the classic vasomotor symptom of hot flashes. These include inflammatory conditions, cardiac and neurological issues, sexual dysfunction, and sleep and mood disorders. Women frequently find themselves referred to numerous specialists to address the multitude of symptoms associated with menopause, with each symptom being tackled individually; clinicians unable to connect the dots, akin to playing a game of whack-a-mole with symptoms.

How is this reality not the ultimate in over-medicalization? If and when doctors do engage their patients in discussions of menopausal hormone therapy—a proven treatment to both allay and prevent many of these conditions—many of them overemphasize the risks and downplay the benefits of hormone-based treatment. And in the series, alternative pharmaceuticals, such as anticholinergics, SSRIs, statin therapy, pain medications, osteoporosis drugs, neurokinin receptor agonists are painted as all benefit and little risk. Patients then are left with a cabinet full of prescription medications, costly medical bills and negligible relief. This is the true over-medicalization of menopause, just not in the way the authors of The Lancet series suggest. We will continue to prioritize patient empowerment, based on up-to-date science and further work to elevate standards of care for women entering the menopausal transition. They deserve nothing less.

https://msmagazine.com/2024/04/15/menopause-treatment-the-lancet/

[slightlv]

1. Yry going to the doc

With menopausal symptoms after you've had a partial hysterectomy! They removed my uterus but kept the tube's intact... against my expressed wishes, since I was prone to cysts and HST showed I was already entering menopause. But to most docs, it truly is all in your head... even if you repeat "partial hystetectomy" they act like you're done and over with, not realizing that still having the rest of the plumbing intact means you'll go thru a more or less normal menopause.

I started out treating myself with herbs...black cohosh, I think for hot flashes, and valerian for sleep. Eventually I got into an office with a female doc who truly listened and put me on HRT. It was like night and day in the way I felt. Many will try to scare you to death about HRT just like they did when you first went in asking for birth control pills. Im here to say Yippee for HRT!

[BlueSky3]

2. It's not for everyone.

HRT can cause a host of problems. I had to have a bit of surgery thanks to HRT, so buyer beware. I’m happy it works for you.

[slightlv]

3. You're right, of course... each of us is different in our own ways.

But my god, this was such a life safer for me, I don't think I'd have been able to keep a job without it at the time. I also heard all the scare stories about birth control pills when I hit 29. No way I was giving those up... I DO think whatever is mentioned or talked about by ANYBODY... professional, friend, or acquaintance needs to be run through a person's own critical thinking. I mean, I've lost track of the decades of scare stories about pot and what it will end up doing to you. Now I'm only wishing I lived in a less backward state. When it comes to health, and especially if you're a woman, the word is "caution" in very uncautious ways, IMO.