Falling Short
5 minute read
Last Monday night, TV presenter Davina McCall’s second documentary on Menopause aired on Channel 4. After it, the floodgates opened for so many women. Relieved to finally see other women speaking about symptoms they have experienced, shocked by statistics revealed in the programme and moved by Davina’s own personal experience, women took to social media in their thousands to vent their frustration at the lack of awareness around a medical inevitability that affects half of the population.
The documentary highlighted two things in particular that got people talking: the link between menopause and dementia, and the shortage of HRT on the market. Dementia and menopause have been discussed before, but on Monday night’s programme, Davina spoke to two doctors, Dr Lisa Mosconi and Dr Roberta Brinton, who have spent decades looking at how women’s brains are altered when oestrogen levels decrease.
Dr Mosconi said: “As a society we associate menopause with the function of the ovaries, but when women say they have the hot flushes, the night sweats, the insomnia, the anxiety, depression, brain fog – those symptoms don’t start in the ovaries. Those symptoms start in the brain.”
“Menopause is like a renovation project on the brain,” said Dr Brinton. “A restructuring, a rewiring. The brain is very clearly telling you: “I am under stress; I am in distress.” The idea we can just suck it up is actually deleterious to women’s long-term health.”
She added, “The use of oestrogen and hormone therapy at the time of menopausal symptoms [is crucial] – not ten, not 15 years later; the brain has already changed and it’s no longer going to be responsive to oestrogen therapy.” Their research has shown that HRT is much more beneficial at the start of perimenopause when hormone levels begin to decline. That is when brains start to change.
On social media there was a rush of conversation around menopause and dementia, with women who are not currently on HRT desperately asking if they should be. The British Menopause Society released a statement the next day:
“Women should be reassured that HRT is unlikely to increase the risk of dementia or to have a detrimental effect on cognitive function in women initiating HRT before the age of 65. However, HRT should not be initiated for the purpose of reducing the risk of dementia in postmenopausal women and at this time, there is not enough evidence to support prescribing HRT for prevention of dementia.”
Dr Mary Ryan agrees with this. She says that there are a number of causes of dementia and that there are other areas in our lives that we need to look at first. On her Instagram page @drmaryryan (a brilliant resource for women’s hormonal health) she said: “I have had so many messages from you all about the statement from the British Menopause Society. The most important thing that all women must remember is that for good cognitive and brain health we need to look at a lot of factors. We need to keep our weight normal, avoid abdominal obesity, keep your cholesterol, and blood pressure normal and quit smoking if you are a smoker. All of this prevents brain atrophy. The research is still ongoing with regard to HRT and dementia but it is not detrimental and it is also not the only important factor so let’s keep things in perspective. The wonderful thing about this is that there is research that is active for the first time in generations to benefit women. It is about time, but we are delighted and grateful it is happening.”
Dr Ryan also cautioned women to be careful about where they get their facts around women’s health and warned against people or companies preying on women at a vulnerable time in their lives. “There is a lot of misinformation going on. Make sure you’re getting information from good sources,” she said.
The second thing the documentary highlighted was the shortage of HRT available for women who want it. Because of increasing awareness and education around menopause and perimenopause with thanks to women like Davina McCall, Dr Ryan and Catherine O’Keeffe (@wellnesswarrior.ie), who is running the Menopause Success Summit in Cork this month, there has been an increased demand for HRT.
The current shortage isn’t something new though. In the UK it goes back as far as 2019 and in Ireland there’s a 2020 HSE document talking about the difficulties around sourcing some forms of HRT. The pandemic didn’t help with supplies and so there are incidences now where some women cannot source their preferred medication. GP Dr Illona Duffy was on The Last Word with Matt Cooper this week to talk about those shortages. She said that women shouldn’t be too worried.
“I think at the moment, some forms of HRT are kind of in restricted supply. Throughout Covid, various forms of HRT went into short supply and no supply, but there is always some form of it available. The big crisis now is with Oestrogel, an Oestrogen in the form of a gel that women would put on every day. It’s in very short supply but there is another form of the gel called Divigel and if you can’t get the gel for a while we can put you on a patch or if there aren’t patches available there are tablets short-term. We do like to give the Oestrogen through the skin – that’s what we call transdermally – because it’s the safest way as it reduces your risk of clots. However, in the short-term if you’re not high risk and we can’t get any of those, there is always the tablet. So, what I would say to women is don’t panic. There are various forms of HRT out there. It may mean changing and swapping for a while, but we can sort it out.”
More than anything there is huge frustration with the slow pace of research around menopause and the shortage of medication available. It is yet another women’s health issue that is only beginning to gain focus. Sadly, there’s nothing new in that.
Jennifer Stevens, May 2022
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