Cautioning Against Overmedication in Menopause

Cautioning Against Overmedication in Menopause

The Lancet recently released a series on menopause with a warning against excessive medicalisation and a call for an empowerment approach. The Australasian Menopause Society (AMS) also advocates for empowering women to manage their menopause, post-menopausal health, and well-being, as reflected in their tagline “Empowering menopausal women.” However, a significant portion of women (over 25%) experience moderate to severe symptoms that negatively impact their quality of life. In such cases, menopausal hormone therapy (MHT) is an evidence-based first-line treatment option. In response to the Lancet series, AMS and IMS Past-Presidents Professors Susan Davis AO and Rod Baber AM offer their thoughts.

Mental Health & Menopause

The four papers published in the Lancet do not present new research findings but offer perspectives on how menopause can be viewed and optimised. It is concerning that the lead article claims that the principles of health empowerment have not been applied to menopause when, in fact, national and international organisations like the Australasian and International Menopause Societies and Jean Hailes for Women’s Health have been promoting this approach for many years. The papers also address the issue of attributing psychological symptoms to menopause, which is not a new concept and has been highlighted in recent reviews. This serves as a reminder to women and clinicians not to attribute every symptom to menopause. The authors acknowledge that the majority of women will not experience severe menopausal symptoms, but 60-80% will experience hot flushes and night sweats for an average of 7 years, with 1 in 3 women experiencing severe symptoms.

The Problems of Finding the Right Medication

While the Lancet series cautions against over-medicalisation of menopause, their messaging on therapy can be confusing. For example, they recommend specific MHT, gabapentin, and oxybutynin, which have mild to moderate efficacy in reducing hot flushes by 1-2 per day, but they also acknowledge that MHT is effective in reducing symptoms by 2-4 per day and improving quality of life. Additionally, the promotion of gabapentin and oxybutynin is concerning, as these treatments are not approved for menopausal symptoms and have limited data. In contrast, fezolinetant, which has been approved for vasomotor symptoms in several countries, is downplayed despite robust evidence, while other non-hormonal therapies lack evidence.

Other Complications with Menopause

The Lancet series also acknowledges the importance of bone loss during menopause and the effectiveness of MHT in preventing fractures but questions the long-term effects of menopause on overall health. This goes against other expert opinions and highlights that this series presents only one interpretation of research findings. The authors seem to downplay the important role of MHT in helping women during menopause and ignore other systematic reviews that support MHT as the most effective treatment for vasomotor symptoms and comparable to other therapies in preventing osteoporosis and fractures without an increased risk upon stopping treatment.

Conclusion

Current guidance from international and national menopause societies, including Australia and New Zealand, emphasises the importance of an evidence-based approach and providing individualised care, support, and treatment for women during this significant stage of their lives. Overall, these papers align with the 2023 Practitioner Toolkit for Managing Menopause, which promotes an evidence-based approach and empowers women through accessible online resources, as recommended by the papers. (Mehta and Manson, 2024; Gersh et al., 2024; Davis et al., 2023)

Monisha Dadlani & AM Team

MsC., MoC. Member of: ACA, BACP

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Disclaimer: This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding a medical condition.