DR MARGARET MCCARTNEY: The menopause isn't just some 'problem' that can only be solved with HRT

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HRT ― hormone 交替／補充 therapy ― is hardly out of the news.

From 落ちるing out of favour in the 早期に 2000s, in the past few years its rise has been unstoppable ― in 2022-2023 the NHS 手渡すd out 47 per cent more HRT prescriptions than the previous year.

It's hardly a surprise, given the 量 of publicity, celebrity 裏書，是認s on TV and social マスコミ, and the （人命などを）奪う，主張するs made about it. There's no 疑問 that HRT is a very 効果的な 治療 for the classic menopausal symptoms of hot 紅潮／摘発するs and night sweats. However, 約束s on social マスコミ go way beyond that.

They 申し込む／申し出 広大な／多数の／重要な 肌, 'vitality', 'new energy', 救済 from 苦悩, 'brain 霧', muscle 苦痛 and 疲労，（軍の）雑役. Instagram is 十分な of 中央の-life women looking fantastic and 是認するing HRT. Closer to home, presenter Davina McCall has said that 存在 on HRT is 'going to 肉親，親類d of 供給する me with a bit more 保護 [from Alzheimer's] than it would if I wasn't'.

The subliminal message is that menopause is a 医療の problem and it needs to be 扱う／治療するd.

In 2022-2023 the NHS?手渡すd out 47 per cent more HRT prescriptions than the previous year (在庫／株 Image)

Now a 一連の articles in The Lancet, by a group of 著名な 研究員s in women's health, has called for more nuance over the menopause and ways we 扱う／治療する it.

Even the 指名する 'hormone 交替／補充 therapy' 暗示するs that women are deficient ― the 研究員s 言及する to it as 'menopausal hormonal therapy'.

意味ありげに, they say that '商業の companies and individuals with vested 利益／興味s have over-medicalised menopause' and that 'でっちあげる，人を罪に陥れるing of this natural period of 移行 as a 病気 of oestrogen 欠陥／不足, that can be 緩和するd only by 取って代わるing the 行方不明の hormones, 燃料s 消極的な 態度s to menopause and 悪化させるs stigma'.

I have to agree. I remember, years ago, women rightly 存在 annoyed when told by their doctors that every last symptom they had was 負かす／撃墜する to 'their hormones', when 現実に they had other 条件s that weren't 存在 調査／捜査するd. We seem to have come 十分な circle.

Some women 明確に do have a di fficult menopause, with 厳しい and 多重の symptoms, and experience 広大な／多数の／重要な 利益 from HRT.

Presenter Davina McCall?has said that 存在 on HRT is 'going to 肉親，親類d of 供給する me with a bit more 保護 [from Alzheimer's] than it would if I wasn't'

But there are also women who are disappointed by it and find it doesn't live up to some of the （人命などを）奪う，主張するs made on social マスコミ.

There are also plenty of other women who don't feel the need for any 治療, or who can't take HRT (for example, women with breast 癌), wondering whether they are 非難するing themselves to dementia or a heart attack by not putting on the patches.

The question is how to 確実にする women get high-質 （警察などへの）密告，告訴（状） that isn't biased or overpromising what HRT can 配達する.

Last year, に引き続いて its own 調査, the All-Party 議会の Group (APPG) on menopause published a manifesto. It 含むd a call to financially incentivise GPs to 診断する menopause and to licen se a 女性（の）-明確な／細部 testosterone (現在／一般に women 定める／命ずるd testosterone have it on an off-label basis as there isn't a 女性（の）-明確な／細部 製品 licensed in the UK).

But 財政上の incentives for diagnosis can have unintended consequences, such as 'diagnostic 影を投げかけるing', where other 条件s are not 公正に／かなり considered.

And imagine thinking that your doctor was only considering 診断するing menopause ーするために earn money from your diagnosis.

There are women who are disappointed by HRT and find it doesn't live up to some of the （人命などを）奪う，主張するs made on social マスコミ (在庫／株 Image)

As for testosterone, the APPG said there is 'some 証拠' it will 扱う／治療する 疲労，（軍の）雑役 and 'brain 霧' ― but an 独立した・無所属 review in 2019 did not find proof for this. It （機の）カム as no surprise to me that the APPG's 調査 and manifesto were 基金d by 麻薬 companies ― 含むing Astellas, Bayer and Theramex, which either make or are developing 医薬s for use in menopause ― with both 研究d by Dentons 全世界の 助言者s (which has 非常に／多数の pharma cl ients).

非，不，無 of this means HRT doesn't work, but it does 危険 women 存在 oversold a 治療 that comes with the 危険 of 味方する-影響s and won't do what is 約束d.

Menopause can 結局最後にはーなる 現在のd as a simple problem to be solved ― a menopausal woman is deficient in hormones and therefore needs them 取って代わるd ― rather than a コンビナート／複合体, nuanced picture (some women will 利益 from hormones, others will not; some symptoms may be 原因（となる）d by menopause, others not; some women will have few symptoms, others will not).

Take the social マスコミ （激しい）反発 to 草案 指導／手引 on menopause 問題／発行するd last year, when the 国家の 学校／設ける for Health and Care Excellence (NICE) 示唆するd cognitive behavioural therapy (CBT) can help some women manage symptoms. This drew （民事の）告訴s that symptoms were 存在 解任するd as 'all in the mind'.

Yet there is good 証拠 that many women find CBT useful: it's already used for other 条件s, 含むing chronic 苦痛, and is about giving people helpful ways to を取り引きする symptoms ― not 説 their very real symptoms are 'just' psychological.

There should be room for choice in 証拠-based approaches, but the 現在の HRT-menopause axis doesn't 許す for this.

一方／合間, it's （疑いを）晴らす menopause is 運動ing a growing 産業 keen to sell 製品s 恐らく designed for fiftysomething women. Instagram is 十分な of 補足（する）s, 肌 and hair care, all 趣旨ing to 配達する menopausal 利益s.

I've spoken to several young women who are watching the ニュース報道 with a 静かな dread, afraid of their menopause to come.

Dr McCartney believes 'there should be room for choice in 証拠-based approaches, but the 現在の HRT-menopause axis doesn't 許す for this' (在庫／株 Image)

Yes, some women have a terrible time. But we 借りがある it to women of all ages to make it plain that for some it's a 解放, 解放する／自由な from periods and the need for contraception ― and for others, symptoms are 穏やかな and it's rather a 非，不，無-event.

Women are still losing out ― we might have more '認識／意識性' of the menopause but I don't think this has come with better （警察などへの）密告，告訴（状）.

So how do we make better choices? 捜し出す 独立した・無所属 （警察などへの）密告，告訴（状） ― from organisations that don't have vested 利益／興味s, aren't 基金d by pharma and who won't make money by selling you stuff.

I also look for （警察などへの）密告，告訴（状） where I can see the 反対／詐欺s and プロの／賛成のs 公正に／かなり laid out ― 奇蹟 cures don't 存在する.

Finding a way through hype and sales pitches is not for the faint-hearted, but if there ever was a need to try to find unbiased 医療の advice, it's here.

Dr McCartney is a GP in Glasgow and a 上級の lecturer at the University of St Andrews.