Hi lovely subscribers! And a big hello and welcome to my new subscribers. It’s great to have you here.
I’ve completely neglected this Substack for the past couple of months, and I’m really sorry about that.
The reason is that I’ve been hard at work finishing my next book. For me, the way to do that was to cut out all the extra work: no journalism; no other writing and not much engagement on social media. All those little distractions get in the way of a big project, so I’ve basically turned myself into a hermit over these past winter months to get this deadline met.
And good news: I finished it! At least, the first draft, which I submitted to the publisher on Monday. I feel completely empty right now – my brain is not up to much, but I’ll be revived in a few days. Sometimes you need to give yourself permission to take it easy for a bit, I think.
There’ll still be some work to do on the book – which is about healthy ageing, and re-framing, in a way, ageing for women – and it won’t be out until next year. Book publishing is a slow business! But I’ve really enjoyed doing a whole lot more learning while writing it. I’ll share a few tidbits here in the next few months.
In the meantime: what’s been going on in the menopause world lately?
Well, a new review paper on menopause has been published by some well-known clinicians in this space, including Professor Susan R. Davis, who is an Australian endocrinologist who’s a past president of the International Menopause Society and the Australasian Menopause Society. The paper’s pretty wide-ranging, covering the terminology we use to describe menopause; the biology of what’s going on in the body; symptoms and life consequences; treatments and knowledge gaps. It’s a really interesting read (you can read the whole thing here ).
Or at least it is for me, since I am someone who enjoys geeking out on research papers. I get that this may not be you, however.
So I thought I’d give you my bullet-point rundown of things I thought were interesting in this:
The authors reckon we should re-define what menopause is. Usually defined as ‘the time of a woman’s last menstrual bleed’ or at least, one year after this last bleed to define menopause proper, the authors say ‘this definition… does not apply to women with irregular periods or amenorrhea due to a variety of causes prior to their natural menopause transition.’ It also doesn’t apply to people using contraception, like an IUD, which means there are no bleeds. So they propose this: ‘final cessation of ovarian function comprising loss of reproductive hormone production and irreversible loss of fertility.’
It’s not catchy, but I can see where they are coming from.
Menopause is an opportunity! I use that as a slide in my talks, and I’m so happy to see it echoed here in this paper. ‘Optimizing health at menopause is the gateway to healthy aging for women’, the authors say. And I say, Amen to that. Now’s the time to decide how we want the next 40 or more years to be, and take action towards that.
The ‘silent health consequences’ of menopause are worth focusing on. They include increased risk of CVD, diabetes, cancers associated with central adiposity (ie fat around the middle) and bone loss and fragility fracture. Whether or not we have symptoms, these increased risks are real, and need to be managed. There’s a ton of info on how to do that, handily, in my book.
Bones and muscles work together. Again, we know this, but it’s good to see it reported in this way. Here’s what they say:
‘The shared embryogenesis of bone and skeletal muscle, combined with the positive association between muscle mass and bone mineral content throughout life, has led to the recognition of the importance of the bone-muscle unit. Muscle proteins modulate bone turnover, whereas bone proteins exert anabolic effects on muscle.’
The authors highlight that when we work muscles and put a mechanical load on the bones, it helps bone remodel. ‘Low muscle mass and function not only increase the risk of falls but are also intimately related to low bone mineral density (BMD) and therefore osteopenia and osteoporosis, both of which increase a woman’s risk of fracture.’
So: yet another reminder to use it or lose it when it comes to muscle, and that can only be good for your bones, too.
We should be talking more about our vulvas. That’s my phrase, not theirs. But the authors emphasise this: ‘urogenital atrophy is a common and under reported chronic, progressive condition, and bothersome symptoms require long-term treatment. The prevalence of bothersome symptoms has been estimated at approximately 70%.’
Again, we know this: symptoms are progressive, won’t go away on their own, and are very, very common. And treatable! So talk to your doctor about any pain in the vulva, vagina or urethra – you DO NOT have to put up with it.
Alternative therapies probably don’t work. Again, nothing all that new here. They say:
‘Complementary and alternate medicines (CAMs) for menopausal symptoms have been frequently touted, are widely advertised, and have an overall dismal track record of efficacy when subjected to rigorous scientific study.’
That includes black cohosh and phytoestrogens. If they’re working for you, crack on – but if you’re thinking of trying them, give it a short trial and then if you don’t feel an effect, move on.
Menopause is still under-treated. Not everyone has bad symptoms or needs treatment. But, we’re still probably not treating menopause enough. The authors say: ‘Over 85% of women in high-income countries do not receive effective, regulator-approved treatment for their menopausal symptoms.’
And: ‘The proportions of highly symptomatic women not receiving treatment in low- and middle-income countries have not been systematically documented.’
So. Just highlighting the inequity that most likely exists around the world.
Treatment guidelines for HRT/MHT need updating. This is an interesting one. The authors here say that the guideline now followed around the world: that HRT/MHT can be commenced safely for most women before the age of 60, or within 10 years of the last period, need to be reviewed and updated.
‘Evidence to justify applying these age and years-since-menopause limits to the initiation of non-oral estrogen therapy for symptomatic women, or for fracture prevention, is lacking. These blanket recommendations urgently need review.’
These, they say, should probably be relaxed, because they’re based on the WHI study and old formulations of HRT which are very different to what we have now. Which, by the way, they say we also need to study a lot more, since we don’t actually have lots of evidence around the long-term effects or safety of the current formulations, either. And the studies need to be global, so they can be applied globally.
More research is needed. Ah, that old chestnut. But it’s so true here. Here’s what they say:
‘Despite decades of research pertaining to menopause, more work is needed to document the contemporary age of menopause onset, the age of early menopause and POI, and symptom prevalence and health impacts outside high-income countries. Similarly, robust observational studies are needed to better understand the impact of menopause on employment engagement in workplaces, working from home, and on care-providers and volunteers.’
So: as noted by me many times, and by many others: there’s still tons we don’t know about menopause, and tons it would be great to know. In the meantime, be on alert for marketers filling in the knowledge gaps with products… it’s such a sweet spot for anyone wanting to sell something.
See you soon
Niki