Menopause: normalization or treatment?

it’s the British Journal of Medicine, one of the world’s most prestigious medical journals, which (re)launched the controversy in mid-June 2022 by publishing an article questioning the excessive “medical treatment” of menopause. Unanimous view.

Normalizing menopause?

By focusing exclusively on symptoms, we risk fueling women’s fears”, judge the authors, led by Australian gynecologist Martha Hickey. On the contrary, they advocate ‘normalization of menopause’ by insisting on the positive aspects of this period during which women lose their fertility, generally in the early fifties, for example, They cite relief from not having periods.

Insisting on the “natural” nature of menopause, the authors of the article in British Journal of Medicine Focus on one goal: hormone replacement therapy (HRT) prescribed to relieve hot flashes or insomnia. Without completely discrediting them, researchers accuse them of linking menopause with the idea of ​​”regression,” which they wish to reverse. They are highly regarded by the media and scientific literature, notably in favor of the pharmaceutical industry.

Menopause is not a disease caused by a lack of estrogen, but a natural occurrence for half of humanity.
Martha Hickey, gynecologist

More broadly, the critics are part of a movement that insists on the social aspect of menopause: they believe that its effects are affected by this cultural context as much as they are by purely physiological processes, and they condemn the sexual and discriminatory nature of more than 50 years of systematic discipline. Medical treatment of the effects of menopause.

“Menopause is not an estrogen deficiency disease, but a natural occurrence for half of humanity,” tweeted Martha Hickney, who condemns the “over-medicalization” of menopause.

Risky treatments?

Once published, the article was heavily criticized by other menopause specialists, who denounced the situation as counterproductive to women’s well-being. The article, they said.It spreads a very dangerous thought: Because menopause is a “normal” stage of aging, should women avoid medical treatment?‘, sorry in a letter to British Journal of Medicine Dozens of doctors, under the care of British gynecologist Louise Newson. They believe this discourse risks diminishing the suffering of many women, who would be denied the means to comfort them.

There are women who are going through this period disastrously embarrassed, and at the moment, in France, they are having a hard time finding someone to treat them.
Ann Gumble, gynecologist

This controversy takes place in a particular media context. Several feminist organizations recently led a campaign in the UK to denounce the difficulty of accessing prescribed hormone replacement therapies for women experiencing the effects of menopause. In France, too, some deplore the arduous conditions of accessing HRT.

The controversy sparked by the BJM article is also the new episode in an old debate about the dangers of these treatments. They are, for example, linked to a slightly higher rate of breast cancer. “We’ve definitely handled a lotadmits French gynecologist Anne Gompel. Possibly due to poor evaluation of side effects, perhaps due to marketing by pharmaceutical companiesShe noted that that was only more than twenty years ago, and the situation changed drastically with the publication of studies highlighting the dangers of these treatments in the early 2000s.

Where does the unbearable begin?

Since then, the scientific literature has grown, qualifying some of the biases in these studies, without being able to determine in detail to what extent the benefits of treatments outweigh the risks. In 2017, the Cochrane website – a database that summarizes the state of knowledge and is a reference in the medical world – concluded that hormonal treatments were sufficient when menopause had “unbearable” effects. But where is the threshold of the intolerable? This is the difficulty faced by clinicians who, after their lack of discrimination, now tend to be overly cautious, according to Anne Gumble.

Back to the lack of medical treatment

The French gynecologist, who admits that the British Medical Journal (BMJ) article is right to decry negative clichés about menopause, therefore considers them far from reality when they call for excessive medical treatment. exactly the contrary, “In recent years, there has been a shortage of medical treatmentAnd she regrets, also considering that the risks of distributed treatments in France are lower than in the Anglo-Saxon countries.There are women going through this period who are disastrously embarrassed, and right now, in France, they are having a terrible time finding someone to treat them.’,” she said, adding that she has had similar reactions from other countries.

#Menopause #normalization #treatment

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