HEALTH

DR MAX PEMBERTON, an NHS psychiatrist and medical doctor, wrote recently on the significant shift in many doctors’ attitude towards Hormone Replacement Therapy (HRT). For far too many years, peri- and post-menopausal women have to had to fight hard for their right to access this medication.

An increasing number of doctors are now open to the idea that prescribing HRT can have real benefits for their patients – and, undoubtedly, this has made a life-changing difference for many women. Even though some 13million women in the UK are going through the menopause, it is estimated that one in four have to visit their GP at least three times before getting appropriate treatment.

Last year, official draft guidelines were issued to GPs which said alternative treatments should be considered. These included talking therapies “alongside or as an alternative to” HRT to help reduce menopause symptoms such as insomnia, low mood, and hot flushes. These guidelines have now been revised with health officials backtracking after accusations of “medical misogyny” – the implication being that menopausal symptoms were “all in the mind”. The guidance issued by NICE now advises that HRT should be offered as the first line of treatment. Some may believe this a positive development, but Dr Pemberton is unsure.

The medic is known to be a keen fan of HRT and he has seen many patients’ lives transformed by it. But he goes on to say that HRT isn’t suitable for everyone and that talking therapies can help those women presenting with symptoms that have a psychological component.

Dr Pemberton says that many women talk about no longer feeling like themselves, a disconcerting sense of something having changed, a vague undercurrent of unease, despair, and discombobulation. Trying to address what causes this turmoil is far more complicated than simply a blip in hormone levels. And neither can it be explained away by a woman’s dissatisfaction with life and her sense of loss and malaise as a chemical reaction.

That’s not to say that hormones don’t play an important part. Medical professionals know that fluctuations in hormones can be responsible for low and poor mood.

Over the years, Dr Pemberton has seen far too many women struggling to cope and for whom HRT has been hugely beneficial – helping them, for instance, to manage anxiety caused by the menopause.

But the medic also believes there are other factors that contribute to a woman’s sense of losing herself. He points out that low mood and anxiety are a result of complex social and psychological factors, rather than simple biology.

Changes to the body, disrupted sleep, hot flushes, and so on, he says, can make any woman feel out of control and depressed.

Dr Pemberton documents and records other issues he’s heard women talk about – for example, erratic mood swings and out-of-character behaviour. There are stories of women having affairs, quitting their jobs, or leaving their husbands around the menopause.

While some would seek to blame this all on fluctuations in hormone levels, the evidence for this isn’t that compelling.

The clinician says it’s not at all clear that drops in oestrogen and progesterone, the female sex hormones that start to decline in menopause, are entirely responsible.

Rather, the medic believes that the menopause acts like a ticking clock. It suddenly makes women open their eyes and review their lives. Much of the trauma and emotional turmoil that besets many women as they navigate menopause isn’t the consequence of fluctuating hormones but of a re-evaluation of their life’ situation. For many, their sense of self and identity is closely bound up with their roles within their family, particularly those who are mothers, who may feel bereft at the prospect of an empty nest.

It is also a cruel aspect of the inequality between the sexes that women have to contend with a society that’s more judgmental about how woman age than men. For a lot of women in their 50s and 60s, they have given the best years of their lives to other people and their careers, and now they’re not sure why. A vast number of menopausal women now feel invisible.

Dr Pemberton has had many menopausal and post-menopausal women attending his clinics and hearing the sad story that they no longer feel like a woman.

It is here, he says, that these people would surely benefit from having the time and space to explore and discuss their feelings and situation. That’s where talking therapies can play a vital role for many who have become desperately unhappy.

In the opinion of Dr Max Pemberton, the answer to many complex problems precipitated by the menopause aren’t always going to be found in HRT pills, patches, and gels.