Three Quarters of Menopausal Women Report Unexpected Symptoms

GLASGOW, Scotland — Three quarters of women going through perimenopause and menopause experience unexpected distressing, debilitating, and embarrassing symptoms but often fail to receive appropriate treatment, a large UK-based survey found.

"For too long, many people have thought of the menopause as just hot flushes and vaginal dryness. But we know hormones work all over our body, so there are many symptoms beyond that," said Daniel Reisel, MBBS, PhD, a gynecologist at University College London, who presented the survey findings at the 2023 annual meeting of the Royal College of General Practitioners.

Primary care physicians in the UK have seen an increase in cases of women presenting with symptoms associated with menopause at a time when the country's Parliament is debating whether all women should have a menopause check-up in their early 40s, he said.

Still, only around 14% of menopausal women in the UK are prescribed hormone replacement therapy (HRT), despite national and international guidelines clearly stating the benefits of the treatment generally outweigh the risks.

Louise Newson, MBChB, who runs the UK's largest menopause clinic, said many women with symptoms of menopause feel the medical system "gaslights" them — dismissing their concerns as trivial or even fabricated.

In her clinic, she typically sees many women with poor sleep, as well as muscle and joint pains. "Yet [when they visit their GPs], they are incorrectly told that it can’t be hormones because they’re still having periods," she said.

Prescribed Antidepressants Often Precede HRT

The new study sought to learn what women knew and experienced with respect to menopause symptoms and what they thought was important.

Of the 5744 women who responded to the survey, 79.4% were aged 40-60 years and 84.6% were White. "The survey respondents were not different from the distribution of ethnicities we see in NHS menopause care," said Reisel, adding that "the barriers are greater for women in poorer areas and for those who are non-White."

A total of 30.4% had two to five hospital consultations before the healthcare professional considered that symptoms were related to changing hormone levels; 38.5% were offered antidepressants before HRT. Nearly all (94.6%) said they had experienced negative mood changes and emotions since becoming perimenopausal or menopausal; of these, 19.1% were formally diagnosed with depression or a mood disorder.

"This all just highlights the frustrations I feel around menopause care," Newson said. "Women are often not given the tools to properly understand what's going on, and then they don't ask for the right treatment, and many are given antidepressants. It's still medicalizing the menopause but in a different way."

Education Gap

The researchers also asked women if they had experienced any surprising or unexpected symptoms since becoming perimenopausal or menopausal. To this question, 74.2% said they had. Joint pain was the most common unexpected issue (34%), followed by dry eyes (26%), heart palpitations (25%), and hair issues such as dryness, thinning, and loss (20%).

Reisel said words used to describe these symptoms in free text responses included "distressing," "debilitating," "depressing," and "embarrassing."

"When an early-50s woman comes to the GP with dry eyes, joint pain, or recurrent urinary tract infections, for example, before prescribing ibuprofen, or antibiotics, GPs should consider replacing a woman’s hormones and then see what is left in terms of symptoms," he said.

Cognitive problems and negative mood changes also are common and often overlooked, Reisel noted. "We often see striking improvements in mood and cognition in women who are prescribed testosterone for low libido, yet symptoms in these areas are not currently an indication to start treatment," he said. "Data from Newson Health show that 18% have suicidal thoughts in the past 2 weeks and not many people think about this."

Much of this lack of understanding around unexpected symptoms relates to a lack of awareness and education. "It goes back to primary and secondary school, and more broadly, these issues are not often talked about in society," he said.

Reisel also noted that language and cultural barriers often stand in the way. "Many cultures don’t discuss menopause and hormone health in general at all. For example, in Bengali, spoken by 300 million people, there is no word in for menopause. So many women are gaslighted when they try and describe their symptoms, or they’re simply just unaware."

Reisel and Newson reported no relevant financial relationships.

Royal College of General Practitioners Annual Meeting. Presented October 20, 2023.

Becky McCall is a freelance medical journalist based in London, UK. She has written for Medscape for nearly 15 years.

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