Written by Kathryn Barry (she/her) - Medical Student
Despite only being clinically defined after amenorrhoea (an absence of periods) for at least 12 months, the menopause can be a pivotal moment in a woman’s life for many other reasons.[1] The change in menstrual cycle is a well-recognised manifestation by many, unlike the sexual difficulties, urogenital symptoms, mood changes, musculoskeletal symptoms and vasomotor symptoms that may only become known to menopausal women and their families once the menopause is reached.1 Shame and stigma cloud discussions and prevent many women from seeking help and advice regarding their experiences, allowing myths to spiral through society. A recent documentary by Davina McCall, ‘Sex, Myths and the Menopause’, highlighting her own experiences with menopause aged 44, encouraged dialogue, evidenced by a 250% increase in Google searches for ‘menopause’ following the documentary’s broadcast.[2],[3]
Inspired by McCall’s documentary, I wanted to reveal and debunk some of the most popularly held myths about the menopause.
MYTH: The menopause only lasts a year
FACT: Symptoms typically last 4 years following a woman’s last period. For 1 in every 10 women, symptoms may last for up to 12 years.[4]
MYTH: Contraception is never required after the menopause
FACT: At 55, due to the very low risk of conceiving naturally, all women can stop using contraception to prevent pregnancy. To avoid acquiring sexually transmitted infections, it is advised to continue using a barrier method of contraception, such as condoms.[5]
MYTH: The only management doctors suggest is Hormone Replacement Therapy
FACT: Treatments for symptoms of the menopause are broadly split into hormonal (for example hormone replacement therapy), non-hormonal (for example
clonidine) and non-pharmaceutical (for example cognitive behavioural therapy, CBT). The management plans should be tailored to each individual patient, and should always take the patient’s views into consideration, following discussion of short-term and long-term benefits and risks.1
MYTH: Hormone Replacement Therapy is always dangerous
FACT: Whilst the risk of venous thromboembolism is increased by oral HRT, this is not the case with transdermal HRT, which may be a more suitable preparation for those at an already increased risk of VTE.
The risk of dying from cardiovascular disease is not affected by HRT. When started in those aged under 60 years, there is no increased cardiovascular disease risk.
Oestrogen-only HRT is associated with no or reduced risk of coronary heart disease, and HRT with oestrogen and progestogen is associated with little or no increased risk of coronary heart disease.
Oral oestrogen gives a small increased risk of stroke, unlike transdermal oestrogen.
HRT is not associated with Type 2 diabetes mellitus or adverse blood glucose control.
There is a decreased risk of fragility fracture in those taking HRT.
Oestrogen-only HRT is associated with no or little increased risk of breast cancer, and HRT with oestrogen and progestogen is associated with an increased risk of breast cancer. The increased risk of breast cancer is associated with treatment duration and reduces again following treatment cessation.
Limited evidence suggests HRT may improve muscle mass and strength.
HRT is primarily used to control vasomotor symptoms experienced during the menopause.
It is important to note that risks associated with HRT are individual and therefore speaking with a doctor regarding individual circumstance is paramount.1
MYTH: Cervical screening is not needed after the menopause
FACT: In the UK, women and people with a cervix between the ages of 50 to 64 are invited for cervical screening every 5 years. Those aged 65 or older are invited to attend if 1 of their last 3 tests was recorded abnormal. Cervical screening is important to detect the presence of human papillomavirus (HPV) as certain strains of the virus can cause dysplastic and later neoplastic changes.[6]
There is so much unknown regarding a stage that is experienced by half of the population, and it is therefore paramount to continue these conversations regarding the menopause and encourage those suffering to seek help and advice when they feel it is necessary.
References [1] National Institute for Health and Care Excellence. Menopause: diagnosis and management [Internet]. 2015 [London]: NICE; [updated 2019 Dec; cited 2021 Jun 21]. (NICE Guideline [NG23]). Available from: https://www.nice.org.uk/guidance/ng23 [2] Davina McCall: Sex, Myths and the Menopause. Linda Sands. Finestripe Productions Ltd. 2021. Available from: https://www.channel4.com/programmes/davina-mccall-sex-myths-and-the-menopause/on-demand/71025-001 [3] Google Trends. Menopause [Internet]. 2021 [California]: Google; [updated 2021 Jun; cited 2021 Jun 21]. Available from: https://trends.google.com/trends/explore?date=today%205-y&geo=GB&q=menopause [4] NHS. Menopause: Symptoms [Internet]. 2018 [England]: NHS; [cited 2021 Jun 21]. Available from: https://www.nhs.uk/conditions/menopause/symptoms/ [5] NHS. How do I know I’ve reached menopause if I’m on the pill? [Internet]. 2020 [England]: NHS; [cited 2021 Jun 21]. Available from: https://www.nhs.uk/conditions/contraception/menopause-contraceptive-pill/ [6] NHS. Cervical Screening: When you'll be invited [Internet]. 2020 [England]: NHS; [cited 2021 Jun 21]. Available from: https://www.nhs.uk/conditions/cervical-screening/when-youll-be-invited/
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