How menopause affects women and why we should offer treatment

Deborah Evans is a pharmacist and independent prescriber who specialises in women’s reproductive and sexual health, including the menopause. She owns and runs Remedi Health, an independent pharmacy and healthcare clinic in Winchester. IMI spoke to Mrs Evans to find out more about the menopause clinic and the guiding principles behind it.

There is a considerable unmet need for menopause services. “I think at the moment the data suggests only about 15% of women are prescribed hormone replacement – that’s 85% of women who are not. ……  In the main I would say there are many, many, many women from [their] 40s, if not before, and upwards through to end of life who are suffering needlessly as a result of not being listened to and treated”, says Mrs Evans.  Some women will experience a natural menopause that can take several years and others will experience an abrupt menopause as a result of surgery or chemotherapy. There is a belief that “we get through the menopause” but “in my experience, both personally and professionally, I think many problems only just begin once periods have stopped and the menopause has been met”, she says.

Menopause symptoms are many and various. While hot flushes and brain fog are often mentioned, declining levels of oestrogen and other hormones have wider effects. Also, these come at a time of life when women can be managing teenage children, ageing parents and busy careers – and so problems are often put down to stress. Oestrogen, progesterone and testosterone are not just our sexual and reproductive hormones – “they are all powerful neurological hormones which means they have a big impact on the brain so when they’re either out of balance, fluctuating or in decline or all three – then we can really feel it mentally”, says Mrs Evans. Some women experience anxiety and depression for the first time with the menopause and those who’ve had it in the past can feel significantly worse. Cognitive function can decline and women describe brain fog and memory loss. Other troublesome symptoms include loss of libido, sleep difficulties, joint pains, pins and needles, tinnitus, dry eyes, dry skin, sore mouth, bleeding gums, flare-ups of irritable bowel syndrome (IBS). About 30% of women do not experience hot flushes, she notes. There is also genitourinary syndrome of the menopause (GSM)  characterised by combined vulvovaginal and urinary tract symptoms as a result of thinning of the tissues of the vulva, vagina, urethra, and bladder caused by oestrogen deficiency. “It’s a peak time for women to seek referrals to specialists when, in actual fact, addressing their hormone decline would make all the difference to how they feel and their symptoms”, she says.

In the past the risks of hormone replacement therapy (HRT) were very heavily emphasised and much of this type information is still around – and it frightens women off HRT.  Whilst a healthy lifestyle can help, “I think it’s really important to understand the role that HRT plays in addressing the symptoms that I’ve described …… Fundamentally unless we’re addressing the decline in hormones then we can’t fully address the symptoms”, says Mrs Evans. The benefits of HRT also need to understood – “What we now know from the evidence is that women as a population who take HRT live longer from all-cause mortality than women that don’t take HRT and this is because living with long-term hormone deficiency, particularly oestrogen, carries risks”, she explains. These are increased risks of cardiovascular disease (e.g. heart attacks and strokes), type 2 diabetes,  osteoporosis (where oestrogen replacement is a first-line therapy) and some cancers (e.g. bowel and bladder). In addition, there’s emerging evidence to suggest that Alzheimer’s disease increases as well. “So, by taking HRT women are not just addressing their immediate symptoms, which can go long beyond the menopause itself, but also looking at protecting their long-term health and we know from the evidence ……. that those benefits for health protection are particularly relevant if you start HRT within 10 years of completing the menopause – so one year post-[last]-period – and/or under the age of 60 [years]. ….. I hear a lot of women say to me, “Oh well,  I’ve got through the menopause;  my mother got through it – I’m going to get through it”, as if we’re going to get some sort of badge of honour! …..  The reality is that before the health protection elements that we now have we weren’t living much beyond our reproductive years. So, I don’t believe it’s natural to live in this [state of oestrogen-deprivation] and, in fact, if it was any other hormone, such as thyroid, we would replace it without [further] thought”.

About Deborah Evans

Deborah Evans is a pharmacist independent prescriber who specialises in women’s reproductive and sexual health, including the menopause. She owns and runs Remedi Health, a clinic in Winchester, Hampshire. She combines the roles of Clinic Director, Superintendent Pharmacist and hands-on practitioner.

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