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Menopause is not a disease
I wanted to write an article for International Women’s Day to celebrate the amazing progress the world is making in women’s health, in particular brain health and mental wellbeing.

I wanted to rejoice with you how we are finally beginning to educate and support women through the huge hormonal and neurological transitions of postpartum and menopause, so women can thrive.

But then The Lancet’s series on menopause came out on Wednesday and took us straight back to 2002.

The commentary Time for a balanced conversation about menopause suggests more empathy by prescribing physicians, yet cites outdated studies to scare women and gaslight their experiences. They suggest that menopause is a natural process (Yes!) that has been overmedicalised (No!) and is being positioned as a disease (No!)

Menopause is not a disease; it is a transition due to declining hormones that can lead to disease.

Menopause (the end of the menstrual period) occurs due a reduction in hormones (oestrogen, progesterone and testosterone) from the ovaries i.e., there are no more eggs being released, so women can’t get pregnant. This is not a chance occurrence (or a measure of probability), it is a medical fact! A woman’s hormones will decline as she enters midlife (sometimes even before). It happens to every biological female if she lives long enough.

But it isn’t just a sudden stop of periods. For reasons we don’t know yet (but I am sure it is at least in part to do with the brain needing time to adapt to the reduction in hormones) there is a long transition period into menopause, known as perimenopause. This is a turbulent hormonal time for most women, that can last from a few months to 10 years.

80% of women in Australia report experiencing perimenopausal symptoms, which are due to the reduction in hormones.

Let me tell you in simple science why.

The body and the brain have an abundance of oestrogen receptors. These need oestrogen to bind to them so they can carry out their function; like decreasing inflammation, lubricating joints (and your vagina), regulating neurotransmitters, protecting your heart, your bones, and your brain.

 

Think of an oestrogen receptor like a light fitting, and oestrogen like a light bulb. Only when the lightbulb (oestrogen) is in the light fitting (receptor) will the area be illuminated (function). 

 

Otherwise it is dark, much like the experience of perimenopause for many women.

This is a medical fact that does not paint menopause as a disease. However, this oestrogen deficiency can lead to many diseases in older age including cardiovascular disease, osteoporosis, and dementia.

To suggest that replacing hormones in perimenopause, so a woman can increase her physical and mental wellbeing, makes it a disease, devalues and excludes women. This is not at all in line with the International Women’s Day 2024 theme of “inspiring inclusion”.

For some women perimenopause is too much to bear.
Statistics show that suicide in midlife-aged women increases tremendously, as does depression, women leaving their jobs and alcohol consumption.

 

You don’t have to take Hormone Replacement Therapy (HRT) when your hormones start to decline, but you need to know how the reduction in hormones may affect you physically, psychologically, emotionally, socially, and even spiritually, so you can make educated decisions about your current health and your health into older age.

It is inspiring and empowering when a woman takes her health into her own hands and decides she wants better for herself. Every woman is unique, and menopause is not a one-size-fits-all experience. My advice is read and research what you can, and find a doctor who is educated on the latest research, who has your back and who honours your personal experience.
If you read information ask who wrote it, who sponsored it and what have they got to gain from it (yes, even ask that about me!). You don’t need to white-knuckle through perimenopause and play down how you feel. You deserve a wonderful midlife and you deserve to feel illuminated.

 

Dr Jennifer Hacker Pearson is a PhD-qualified neuroscientist and trained psychotherapist. She teaches science-informed education and tools to help women boost their brain health and mental wellbeing, from postpartum to menopause, so they can thrive in life and work.

For more see www.DrJen.com.au.