Q&A with Dr Philippa Kaye, author of The M Word: Everything You Need to Know About the Menopause
Published tomorrow, 13 February, The M Word is a complete one-stop guide to the peri-menopause and menopause, covering everything from understanding your symptoms to the impact on working, sex and relationships, and which treatments really work.
Based on the latest medical guidelines and evidence, and written in a positive, light-hearted style, with plenty of anecdotes from real women, The M Word shows you how to not just survive, but thrive through the menopause, letting you remain you.
Its author is Dr Philippa Kaye, a GP with a particular interest in children’s, women’s and sexual health. She has written multiple books on topics ranging from fertility to child development. We sat down with Dr Kaye to find out why the menopause remains so misunderstood, and what women can do if doctors dismiss their symptoms.
What are the biggest myths and misconceptions about the menopause that you come across in your work as a GP?
There are many, many myths, misconceptions, old wives’ tales, and actual misinformation about the menopause. I think the most common misconception, which I challenge on a regular basis, is that women feel that the menopause is something to be feared and something they are going to have to struggle through to get out the other side. That after the menopause they will be useless and have no point to their lives, which of course is incorrect and is a marker of the patriarchal society in which we still live. After our fertile days are over, do we still have a purpose? The answer is of course we still have a purpose, but the feelings and anxieties are still there.
Women in the UK will go through the menopause on average at the age of 51, by which I mean that they will have their last period at that age; we can’t say you have been through the menopause until you haven’t had a period for a year. But you can have symptoms related to the hormonal changes of the menopause for many years before that; this is called the climacteric or perimenopause. The average life expectancy for women in this country is about 80 years old, so we will live approximately one third of our lives after the menopause. This is not something to survive or struggle through. If you need help, ask for it; we have lots of treatments available!
The other main myth or misconception that I see is around the safety of hormone replacement therapy (HRT), that the risks are huge and frightening, and HRT should be avoided at all costs. This is in part due to the media and often scary articles that were written after some studies were published over a decade ago. But research has moved on, and the risks and benefits relating to HRT are now very well known.
The main concern is often about the risk of breast cancer, but it is important to put this into perspective. The background risk of developing breast cancer between the ages of 50 and 59 is 23 per 1000 women, so 2.3%. Having HRT in the form of both progesterone and oestrogen orally (which is a slightly old-fashioned way of doing it; we have better options now!) increases that risk by 4 cases per 1000 women. Compare that to smoking and alcohol, which increase the number of cases by 5 and 3 per 1000 women. Or obesity, which increases the number of cases by a further 24, therefore doubling your risk of developing breast cancer.
Put into context, around things you may already be doing, this risk is small. Using transdermal oestrogen (through the skin) and micronised progesterone, which is the same structure as the progesterone in your body, is likely to have lower risks than the type of HRT used in the studies. Risks of stroke can be mitigated by delivering the oestrogen through the skin as well.
So the risks are present but small, and have to be weighed up against the benefits. Not only that, but your symptoms – both physical and psychological – will improve with HRT, and your risk of developing osteoporosis, heart disease and dementia will decrease. See your doctor, get informed, and ask for help!
When it comes to all the confusion and fear surrounding HRT, is there one key message you want women to take away?
I would advise that women ask their doctor for advice regarding HRT and get their information from trusted resources such as the NHS website.
The main messages are these:
- If you go through a premature menopause there are no increased risks at all associated with HRT up until the age of 51, as we are simply replacing the hormones which would ordinarily be there until that age.
- Between the ages of 50 and 60, the benefits of starting HRT generally outweigh any risks.
- Between 60 and 70, the risks of starting HRT (not continuing it!) and the benefits are about equal.
- The risks of starting HRT after the age of 70 tend to outweigh the benefits.
- There is no defined stopping age for HRT; as long as the benefits outweigh the risks, you can keep going!
Why do you think there is so much misunderstanding and reluctance to seek help for this stage in women’s lives?
Women in society put up with gynaecological and sexual health issues; we always have done. I see women in my clinic all the time who put up with unbearable period pain, or spend a couple of days on the toilet due to how heavy their periods are, and don’t realise that they don’t have to! This isn’t their fault but society has taught women to feel ashamed of their sexuality and their bodies, so it is hard to come forward and ask for help. If you can’t even put a name to your genitals (and many women can or will not) then how can you ask for help about something, or look after it?
Menopause is not talked about and, while you may have learned about sex, conception and puberty at school, you didn’t learn about the menopause. This is in a way extraordinary, as the menopause will affect every single woman at some point, and men are affected too as their partners, mothers, spouses, sisters and friends experience the menopause. This lack of information is hopefully going to change, as in 2019 legislation was passed to put the menopause into the PHSE (personal, health and social education) curriculum at schools.
Add to this the fact that women do not talk to each other about this – mothers don’t inform their children, friends may talk about hot flushes but are less likely to mention flooding periods or painful sex – and it isn’t a wonder that women are reluctant to seek help. If you don’t know what is normal and what is not, if you don’t know that your fatigue, insomnia, mood changes, etc. could be related to the menopause, you don’t know to seek help for it!
Hysterical Women features women’s stories of being dismissed or made to feel their symptoms are all in their heads – is this something you’ve encountered, perhaps with patients coming to you for a second opinion?
The psychological symptoms related to the menopause are wide ranging and include insomnia and fatigue (which can go under both the physical and psychological symptoms), irritability, low mood, depression, anxiety and more. It is only more recently that these have been understood to be related to the menopause, and unfortunately I hear many stories of patients being put on antidepressants inappropriately.
The current guidance is that if depression or anxiety are a new symptom around the time of the menopause – in that you haven’t had them before – then the first line of treatment is HRT and not antidepressants. Talking therapies such as cognitive behavioural therapy do have a role and can help with hot flushes as well as other symptoms.
One of the reasons that the psychological symptoms have been dismissed is the idea of ‘empty nest syndrome’. This is a term which was used to describe feelings of sadness around the time of the menopause, perhaps related to the fact that children are leaving home or relationship difficulties. Not only is the term patronising to women but it doesn’t explain these symptoms in women who haven’t had children!
Unfortunately, women feeling dismissed or that their symptoms are in their heads is not unusual, and many patients describe feeling relieved when their voices are heard. It is one of the many reasons why we need to keep talking about it!
How can GPs better support their patients dealing with menopausal symptoms?
GPs have to do regular learning in their jobs; medicine changes all the time and we need to keep up. This applies to the menopause as much as any other area of medicine. Some GPs are more informed than others with regards to menopause and its treatment. Often within a practice there will be someone with extra qualifications or an interest in women’s health who will be the best person to go to. While I may be the right person for women’s health, I don’t carry out joint injections or minor surgery, so I wouldn’t be the right person to see for those issues! Ask the receptionist and try to book, if possible, with a doctor with an interest in women’s health, if your surgery has one.
What do you hope The M Word adds to the emerging conversation around the menopause?
I hope that people view The M Word: Everything You Need to Know About the Menopause as an empowering as well as an informative read. As women we have a responsibility to help each other by opening up the conversations around the menopause, its symptoms and its treatments, in order to help each other through this stage in our lives. I hope the book helps to do this! It is evidence and guidelines based, and will help you take control so you can thrive – instead of survive – the menopause!
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