Evidence-based recommendations on menopause management advise individualised care

 

Best practice recommendations for healthcare professionals providing help and support to women experiencing the menopause have been issued in a joint position statement from the British Menopause Society (BMS), Royal College of Obstetricians and Gynaecologists (RCOG) and the Society for Endocrinology (SfE).

 

The statement is in response to growing concerns around hormone replacement therapy (HRT) shortages and provides an expert consensus on best practice for menopause care and treatment, incorporating national and international evidence-based information. The recommendations advise an individualised approach, considering the risks and benefits of therapies as well as lifestyle choices so that women can make informed decisions about their treatment and care.

 

It is estimated that menopause symptoms affect more than 75% of women, with over 25% of women experiencing severe symptoms. These can include hot flushes and night sweats, vaginal dryness, a change in mood and memory problems, many of which can last for several years. These symptoms can have a detrimental impact on women’s quality of life and wellbeing, as well as pose more serious risks to their bone and cardiovascular health. The menopause for many women has been shrouded in stigma and taboo, however in the past couple of years we have seen an uplift in awareness of the menopause and its symptoms through the media. Recent HRT shortages, as well as a plethora of misinformation about menopause in the mainstream media has prompted the preparation of this statement.

 

As a group of medical organisations, the BMS, RCOG and SfE aim to provide evidence-based guidance to healthcare practitioners who work with women experiencing the menopause, to ensure that they have access to accurate information and can help women make informed decisions about their treatment and care. It is important to not only consider HRT, but to also offer advice on lifestyle, such as exercise, optimising weight, stopping smoking, reducing alcohol, as well as the advantages and disadvantages of alternative therapies. The statement advises that the individual needs of each woman be considered, rather than a “one size fits all” approach. It also considers the risks and benefits of hormonal therapies in the context of age, cardiovascular health, cancer status and body weight.

 

Haitham Hamoda, Chairman British Menopause Society says, “Whilst women can access much information on the internet and social media, there unfortunately remains some misinformation. The importance of applying a holistic and individualised approach in the care of women going through the menopause transition was recognised in the NICE guidance in 2015, as well as other national and international guidance documents. It is essential that women are made aware that help and support is available to them and are provided with access to accurate information.”

 

Professor Stephanie Baldeweg, Consultant Endocrinologist and SfE Clinical Committee Chair says, “In recent years, the mainstream media has provoked much positive discussion over what treatments are available and what more could be done to support women going through the menopause. Some reports and headline have been conflicting, so guidance from independent expert governing bodies, through careful consideration of peer reviewed data from a wide range of high quality sources, is very much needed to empower patients, doctors, practitioners and women to make informed choices.”

 

Dr Edward Morris, President of the Royal College of Obstetricians and Gynaecologists (RCOG), says, “It’s clearly been a really distressing time for many women who have tried to access their regular form of HRT and not been able to as a result of these shortages.

 

“The aim of this statement is to provide clear recommendations of best practice for healthcare professionals caring for women and people of all ages who have menopausal symptoms. All women will experience the menopause in different ways and that’s why it’s important they are provided with tailored care that’s right for them.”

 

The menopause is a major life event that can affect women in different ways. An individualised approach in assessing women going through the menopause is essential and it’s important that women are made aware of the help and support available to them, and that they feel able to consult their GP for trusted advice. This Position Statement is intended to provide useful and accurate recommendations for professionals to guide women in finding what’s best for them.

Early menopause in smokers linked to bladder cancer

 

Research shows that experiencing menopause before the age of 45 is associated with a higher risk of bladder cancer. This higher risk was notable if the woman is a smoker. The study, which looked at health outcomes of more than 220,000 US Nurses, is presented at the European Association of Urology congress in Barcelona. Bladder cancer is the 6th most common cancer diagnosed in Europe*. It is more common in men than in women, but women are more likely to suffer from advanced bladder cancer and are less likely to survive than men. Around 27,000 European women and 19,000 US women are diagnosed with bladder cancer each year. The US and European scientists studied the medical history of nurses who had enrolled in the Nurses’ Health Study I and II, which have been following the health outcomes of more than 220,000 US nurses since 1976. They found that women who went into menopause before the age of 45 were 45% more likely to have bladder cancer than those who had later menopause (after 50). If these women had smoked, the risk of bladder cancer was 53% greater than women who had later menopause. Around 1 woman in 20 undergoes early menopause before the age of 45, the average age at menopause is 51 in developed countries. Lead researcher Dr Mohammad Abufaraj (now working at the University of Vienna) commented: “We found that smoking women who experienced menopause before they were 45 years old had a greater risk of bladder cancer. Smoking remains the most important risk factor for bladder cancer. Our data also revealed that it is unlikely that female factors such as age when periods begin, number of pregnancies, oral contraceptive use or the use of hormone replacement therapy are associated with bladder cancer risk. Smoking is associated with earlier age at menopause thereby further increasing the risk of developing bladder cancer.” The number of cases and the number of people who die from bladder cancer varies significantly from country to country. In general, around 3 times more men than women get bladder cancer, but the mortality rate in women is around 40% higher**. There are many explanations for these differences including delay in diagnosis, genetic/epigenetic factors and hormonal factors. Dr Abufaraj added: “This study indicates that earlier age at menopause (that is, shorter reproductive life) seems to increase the risk of bladder cancer. Our primary interpretation is that a factor like smoking, which is known to correlate with earlier age at menopause, remains of grave concern as the main cause of in bladder cancer. It reinforces the warning that smoking really is harmful in ways that we might not have easily imagined.” Previous research from the same research team has shown that smoking has a dose-response relationship with prognosis in both early and advanced bladder cancer. In other words, cigarette consumption worsens outcomes such as response to therapy and mortality. Ten years after stopping smoking, this risk had returned to the same level as that of non-smokers***. Commenting, Professor Arnulf Stenzl, Chairman EAU Scientific Congress Committee (Eberhard-Karls-University in Tübingen) said: “In this long term study, smoking clearly sticks out as the underlying reason for the increased incidence of bladder cancer. However, we need to remain open to other factors causing bladder cancer, such as hormonal changes leading to earlier menopause; this work indicates that these changes may themselves be a result of long term nicotine exposure.” This is an independent comment; Professor Stenzl was not involved in this work.

Thousands of British female employees forced out of the workplace by employers failing to recognise important life stage

In today’s modern world where employers recognise key life stages including pregnancy, bereavement and child-birth, it seems there is one remaining natural life event that is being grossly ignored…the menopause! 

A new government report written by Dr Ros Altmann calls for greater support for workers going through the menopause.  Dr Altmann, Business Champion for Older Workers, who advises the Government on ways to keep older people in the work-force, says employers are failing older women by ignoring ‘the last taboo’

The report calls for more support for women going through this significant life stage and states a lack of support is forcing some women out of their jobs. Dr Altmann says women ‘are being performance-managed out of their jobs.  Dr Altman states the menopause ‘is not on the work radar.  Pregnancy is, childbirth is, berevament is but [menopausal women] get no support in the workplace.’

We asked Dr Marilyn Glenville, the UK’s leading authority on women’s natural health and author of Natural Solutions to Menopause how the menopause affects women and what employers can do to support women going through the menopause…


                                                                            
‘The news that women are being forced out of the workplace because employers are ignoring the impact of the menopause is shocking.  The menopause is just a transition in a woman’s life and if given good advice this transition can be comfortable and easy.  Women can now live 30 to 50 years past the menopause and they want to live that with a good quality of life.’

‘If women are told how to cope and manage this stage in their lives, then they can be very productive and efficient at work.  They have the experience and maturity to do their jobs well and can be very valuable assets to a company.  The menopause should be ‘on the work radar’ because it not only helps women feel well and healthy at this time in their lives, but also helps the company retain and utilise the valuable experience of productive and efficient women.’


How long can the menopause last and what are the symptoms?

‘The average age in the UK is 51 but the menopause can start as early as 40 or as late in life as 55. The menopause typically lasts for about 7 years, but some women can experience symptoms for up to 14 years.

‘Common symptoms can include; hot flushes, night sweats, irritability, declining libido, osteoporosis, weight gain, depression, lack of energy, ageing skin, hair loss, vaginal dryness, mood swings’

How common is it for you to see women complaining of menopausal or peri-menopausal symptoms in your clinics? 

‘It is very common for me to see women complaining of symptoms around this time in their lives.  Of course, the women that are sailing through the menopause don’t need help and so I am usually only seeing those who do.  There are some women though who come into my clinic where the menopause has been easy but they are concerned about their future health and want to stay healthy and mentally sharp, with good bone health and energy so they want to work on prevention.’

Do you think it would be hard for these women to approach their employers about symptoms and possible support, given the current climate?

‘I think it would be very hard and embarrassing for the women where the menopause is affecting them to talk to them employers about this, especially if the employer is a man.  For many women this stage is a very clear signal that they are getting older and would be worried about talking about the symptoms as this may imply tht they are not coping with the job and are not so productive or efficient.  I think they would be worried about losing their job or being made redundant if they spoke out.’

What sorts of initiatives and support could employers introduce to make it easier for women to manage their symptoms and stay in full time employment?

‘I think it would be brilliant if employers could bring in someone like myself to give a ‘training’ day for women on how to cope with the menopause.  This information day should be open to all women in the company, no matter what their age, because if they are given good advice earlier on and prepare for the menopause then they can move through this transition easily and comfortably.  It would be of value to the women definitely but also to the employers as they will then be keeping a valuable member of staff who wants to stay in full time employment who is healthy, productive and efficient.  And with the renewed general health will come less absenteeism across the board for these women.’


Marilyn’s new women’s health retreats at Champneys help empower women of all ages

Dr Marilyn Glenville has joined forces with luxury health spa Champneys in Tring, to deliver a series of women’s wellbeing weekends.  These very special one and two day retreats are led by Dr Glenville herself and offer natural solutions and insight into four significant female issues; Fat Around The Middle, Digestion and IBS, Menopause and Fertility.  Groups are kept small to allow for plenty of time for questions and one to one time.  Each retreat includes full use of all facilities, nutritious meals and a thalassotherapy session.  Champneys.com for booking and more information.