I’m a menopause doctor: so why am I vilified for advising women to get HRT?

The menopause affects 51 per cent of the population directly and the rest indirectly. And yet, even despite a recent surge in the menopause conversation, alarmist and confusing rhetoric surrounding treatment for its symptoms – particularly around HRT – continues to circulate.

Like so many areas of women’s health, the menopause is a sorely underfunded and under-researched topic. I would even go as far to say that the menopause is the most undervalued area of women’s health.

For decades, medical journals and newspapers alike have been filled with studies, research and opinion on maternity care from a variety of perspectives, giving women the knowledge to make their own informed choices. But in regard to the menopause, room for productive debate and innovation is yet to be created.

While the information and care available to women regarding their reproductive health is varied, perimenopausal and menopausal women are still held hostage by outdated and incomplete information on the treatments available for their often-debilitating symptoms. This has allowed the rise of a toxic hierarchy within medical professionals specialising in the menopause, which is worsening.

A few menopause charities, set up as societies and groups, are allowed to control the menopause space regarding education and treatment, despite not being regulatory bodies with any vested authority from the NHS or government.

I, along with all my colleagues, adhere to NICE (National Institute for Health and Care Excellence) guidelines when treating patients, and as a prescribing doctor, I retain the clinical freedom to tailor patients’ treatments according to clinical need. Within an informed consent framework, I provide patients with a treatment plan that suits their individual requirements. And yet, there have been targeted accusations levelled at me, and other doctors, whose approach does not fall in line with the relatively narrow view subscribed to by the loudest menopause charities.

Most menopausal women experience symptoms which can last for years. These include poor memory, fatigue, low mood, anxiety and reduced libido. Oestrogen is an important biologically-active hormone, and studies have shown that the longer women are with low levels of oestrogen (ie, menopausal) the greater the risk of diseases including heart disease, type 2 diabetes, osteoporosis, clinical depression and dementia. The menopause is an economic disaster too – around 10 per cent of women leave their jobs due to their menopausal symptoms and many more reduce their hours or change their jobs and do not go for promotions.

The most evidence-based and cost-effective treatment for the menopause is to replace the missing hormones with hormone replacement therapy (HRT), yet only around 6 per cent of menopausal women receive HRT. There are very few menopause clinics in the UK or abroad and many menopausal women are struggling to receive advice and treatment.

There are relentless stories on social media by women who are turned away from their doctors and denied treatment. Many women are turning to non-evidence-based treatments in desperation.

For decades, healthcare professionals have disagreed about the benefits and potential risks of HRT. They discuss reported risks in old studies which have used older types of HRT. Studies focusing only on the newer types of body-identical HRT have been woefully scant and of poor quality. Traditionally, menopause clinics have been run by gynaecologists, often in hospital settings. But the menopause is a systemic problem affecting the whole body, not a condition exclusively affecting gynaecological organs. Training and education for the menopause has been sparse. Courses about the menopause are expensive and hard to access for many healthcare professionals.

It has become part of my life’s work to further the efforts within the scientific and medical communities which can best help women learn how to treat and manage their symptoms so that they can live full and meaningful lives at any age. And yet I see the political silos around menopause ultimately harming women.

By failing to provide a united front, this has caused confusion to patients and women and has also compromised clinician-patient trust and care. Having different views in medicine is common, which is why we need to enable practitioners to have the space to balance the latest research with clinical experience to provide individualised patient care.

Dr Louise Newson is a GP and menopause specialist. She runs Newson Health Group and is also the creator of the Balance App for menopause health