Let’s talk about the menopause. We really need to! We’ve designated next week Menopause Week on Evidently Cochrane and this afternoon we start a series of six guest blogs on the menopause, from women brave enough to share their experiences and doctors and researchers with the latest evidence on treatments. We’re also supporting Menopause UK in their actions for NHS Change Day on March 11th which they hope will #changethechange.
It’s unthinkable that we wouldn’t tell girls about menstruation, yet this other stage in women’s lives is not freely discussed and women are arriving at it unprepared. This isn’t so in all cultures and in those where aging conveys status the menopause is often treated rather differently. Louise Foxcroft has noted, in her excellent book on the modern menopause, that modern Jewish Orthodox practice has begun to address the silence, with women themselves leading the change and creating new rituals. But for the average Luton Linda or Scarborough Susan there’s a silence about the menopause and it isn’t helpful.
For one thing, it’s a taboo that’s preventing women from getting reliable information to help them manage the changes that come with the menopause and to make choices about treatments that might help with the symptoms that many experience. I saw an article in a woman’s magazine recently that was incredibly coy about the whole business. It talked about mood swings but didn’t want to use the ‘M’ word and there was a distinct lack of information about what might actually help, beyond checking out whether your make-up is up to date.
Much more helpful is the wonderful menopause section of the Healthtalk.org website, where you can watch interviews with women talking about their experiences. The senior researcher on this project, Jenny Hislop, tells us more in the first of our guest blogs.
This project helped tackle a taboo that left senior nurse Anne Cooper, who had successfully managed type 1 diabetes for 35 years, unprepared for the impact the menopause would have on her blood glucose levels, along with memory problems that made her think she was losing her grip. “Why didn’t they tell me?” she asks, in Monday’s blog.
June Girvin is another senior nurse and academic who, as a Professor at the Faculty of Health and Life Science at Oxford Brookes University, knows a thing or two about reliable information, but struggled to find any to help her when she found herself dealing with menopausal symptoms which went beyond her understanding of what to expect. Like Anne, she laments that ‘No-One Told Me’ and is speaking out in a bid to change this for others. You can read June’s blog here.
On Tuesday, new evidence about hormone replacement therapy (HRT) will be published, from a Cochrane review looking at its effects on the heart. The lead author, cardiologist Harry Boardman, has explained the findings in this blog, published on the same day as the review. We’re coming back to HRT on Thursday, in a blog by Martin Hirsch, a doctor who is doing research in endometriosis alongside clinical practice. He explains what endometriosis is, what can be done about it and what we know about HRT for women experiencing the menopause after surgery for endometriosis.
We end the week with a look at sex and the menopause, when physiotherapist and comedian Elaine Miller tackles that double taboo and tells us that, while “what most people need is a good listening to”, there is help for menopausal changes which may threaten to ruin a satisfying sex life. Communication and reliable information are key. Read her blog here.
Providing people with the best available information to help them make decisions about health, whether that’s treatment, screening or lifestyle choices, is what we’re about at Cochrane. Cochrane reviews gather the best evidence addressing a particular question, like ‘can exercise reduce menopausal hot flushes?’. There might be enough evidence to answer that; it might show that there are both risks and benefits that need to be weighed up. It might show that we still don’t know, that there are gaps in research, and this can help prompt future research studies. Like the Cochrane review looking at exercise for hot flushes, which found only one small Clinical trials are research studies involving people who use healthcare services. They often compare a new or different treatment with the best treatment currently available. This is to test whether the new or different treatment is safe, effective and any better than what is currently used. No matter how promising a new treatment may appear during tests in a laboratory, it must go through clinical trials before its benefits and risks can really be known.. Not enough evidence to say whether exercise has any effect.
If women are going to get support and reliable information and if important gaps in our knowledge are to be addressed by new research, we need to break down the menopause taboo. Talking is the first action in Menopause UK’s campaign, which has come about thanks to a collaboration between Suffolk GP Hannah Short and a nurse, Natasha North, who is working as a research programme director in Cape Town. Natasha explains:
“Menopause UK is an advocacy network that works to improve health and care for women affected by menopause. We think that menopause doesn’t get talked about nearly enough, and often when it does it quickly becomes a controversial topic. We are so pleased to see Cochrane helping to clear up some of the lingering confusion around HRT. Women and health professionals need clear, unbiased information so that they can make informed decisions together about how to manage the menopause.
Our #changethechange campaign is one of four grassroots campaigns being featured as part of NHS Change Day, which this year is a call to action (click here to read more about NHS Change Day). We’re asking people to take three actions:
- Get together (join a new online forum to connect and inspire people working to improve menopause health and care)
- Get the facts (access new and up to date information about menopause)
- Get menopause on the agenda (commit to discussing menopause at team, directorate or board meetings)”
Just last week, the government’s older workers’ champion, Ros Altmann, said that women are being forced out of the workplace because employers are ignoring the effects of the menopause. Calling it ‘the last taboo’ Altmann, who is due to report to government on the matter, said employers are failing older women.
A glance at the infographic below shows that this is highly relevant for the NHS, with its high proportion of older, female workers. Take a look too at the Menopause in Numbers infographic. It really is time to start talking and see what we can change.
Join in the conversation and help #changethechange. We’ll be talking on Twitter @ukcochranecentr and @SarahChapman30, along with our Menopause Week team: @anniecoops, @JuneinHE, @GussieGrips @drhannahshort, @menopauseuk, @healthtalkorg, @martinhirsch100 and @harry9bo
Foxcroft L. Hot Flushes, Cold Science. A History of the Modern Menopause. Granta Publications, London; 2009.
Daley A, Stokes-Lampard H, Thomas A, MacArthur C. Exercise for vasomotor menopausal symptoms. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD006108. DOI: 10.1002/14651858.CD006108.pub4. Cochrane summary of this review: http://www.cochrane.org/CD006108/MENSTR_exercise-for-vasomotor-menopausal-symptoms
Baker, Danielle. “Change Day 2015 is more than a pledge, it’s a call to action.” Comment. Health Service Journal, 5 March 2015. Web. 6 March 2015. http://www.hsj.co.uk/5082524.article?WT.tsrc=email&WT.mc_id=Newsletter139#.VPjPMkvA7lJ
Page last updated: 25 January 2017