Doctors should not just ‘stick women on HRT’ during the menopause and it is not a ‘one-size fits all’ solution to health problems, according to the NHS’s top women’s health medic.
Prescriptions for hormone replacement therapy (HRT) have soared in recent years thanks to several high-profile awareness campaigns and government action over a shortage of HRT drugs.
Women have credited the medication to helping with hot flushes, brain fog, joint pain and mood swings.
But Dr Sue Mann, a consultant who is the first NHS national clinical director for women’s health, said this has created a perception that ‘everybody should be on’ the treatment.
She said menopausal women feel like they are ‘missing out’ if they are not prescribed the drugs, which are currently taken by around 2.3 million women in England.
And symptoms might be part of a ‘complex difficult life’ that ‘maybe a medication won’t solve’.
‘It’s a time of life where lots and lots is going on,’ she told The Times. ‘Being very linear about it and saying, “Oh, we’ll just give you some HRT”…I don’t think that’s very empowering for women.’
She said HRT could be ‘brilliant’ at helping with some of the physical symptoms linked to menopause, but should not be automatically prescribed to women presenting with issues such as anxiety.
‘I think we’re being very reductive,’ she added. ‘I’ve seen lots of people respond well, but it’s not everything.’
Instead, HRT should be seen as ‘one raft of options’, with women advised about other treatments such as talking therapies if needed.
Menopause, which usually occurs between the ages of 45 and 55, is when hormone levels fall and women’s periods stop.
HRT provides oestrogen and progestogen through tablets, patches or gels.
Dr Mann, a consultant in reproductive health based at Homerton University Hospital in London, was appointed as the NHS clinical director for women’s health in April.
National HRT shortages led to a Daily Mail campaign, launched in 2022, which called for more women to be made aware of symptoms and treatment options.
Less than a month after the campaign launch the government announced a Serious Shortages Protocol, making it easier for pharmacists to substitute HRT treatments if particular drugs were out of stock.
The Medicines and Healthcare Products Regulatory Agency (MHRA) also made the decision to make a particular form of HRT available over-the-counter in a landmark UK first, and a scheme saving menopausal women more than £200 a year came into force last year.
Earlier this year, separate experts argued menopause is not a disease and is ‘over-medicalised’.
High-income countries, including the UK, commonly see menopause as a medical problem or hormone-deficiency disorder with long-term health risks ‘that are best managed by HRT’, they said.
Yet, around the world, ‘most women navigate menopause without the need for medical treatments’, the experts, including from King’s College London, said.
They argued there is a lack of data on whether health problems are caused by menopause or simply by ageing.
Dr Lydia Brown, from the University of Melbourne, said: ‘Whilst it’s certainly the case that some women have extremely negative experiences of menopause and benefit from hormone therapies, that isn’t the whole picture.
‘The reality is much more complex and varied, with some women reporting neutral experiences and others highlighting good aspects, such as freedom from menstruation and menstrual pain.’
