Self-awareness, self-referral, and self-education
Menopause awareness grew significantly in 2022 and 2023, with more women taking charge of their bodies and demanding better support and understanding in the workplace, media and at a government level.
In 2024, women are increasingly using their own initiative to access effective menopause care. Miss Anne Henderson, Consultant Gynaecologist from Gynae-Expert.co.uk, said: “In my practice, I’ve noticed that the key trends in menopause care are self-awareness, self-referral, and self-education. Women are no longer following the traditional referral pathways through their GP. The vast majority of women self-refer due to awareness of the failings within the NHS and the inability to get decent quality advice.”
Aesthetic clinics becoming first-responders
Aesthetic clinics regularly treat women in their 40s and 50s and are meeting a gap in the market for menopause care.
Jackie Knight, a registered nurse and Principal Practitioner at A New You clinic in Brighton, said: “In the last decade, it is apparent there are ongoing ways for the public to have access to menopausal advice in order for them to make an informed decision about their care during the perimenopause, menopause and post-menopause stages. We are best placed as aesthetic clinics to be able to integrate this advice and education into our practices.”
Personalised hormone replacement therapy
Compounding pharmacies work with menopause specialists to develop and dispense bespoke compounded and bio-identical formulations to treat menopausal symptoms and maintain women’s hormonal health.
Elizabeth Philp Chief Executive Officer and Founder of Roseway Labs, said: “Compounded Bio-identical Hormone Replacement Therapy (BHRT) can offer advantages to patients and prescribers. Bio-identical hormone powders are originally sourced from wild yam and then synthesised in a laboratory to create molecules that are molecularly identical to women’s natural hormones. These active ingredients are compounded to create BHRT precisely targeted at the patients’ needs.
“Personalised medication can ease women’s menopause symptoms, improve their wellbeing and restore their hormonal health.”
Testosterone treatment
Increasingly, women are asking about testosterone treatment as part of their hormone replacement therapy. In 2023, data analysis by The Pharmaceutical Journal showed a ten-fold increase in the number of women prescribed testosterone over the past seven years, with the sharpest rise following Davina McCall’s menopause documentaries.1 Looking forward to 2024, this is likely to be an increasing trend.
Dr Masud Haq, a highly respected consultant in diabetes and endocrinology, said: “There’s been a significant interest in menopausal treatment over the last few years. This has probably been driven by social media and celebrities raising awareness of menopause. This is certainly very welcome, and we should be doing our level best to treat as many women as possible with HRT to improve their quality of lives.
“There are significant benefits with giving testosterone in appropriate women who have features of Hypoactive Sexual Desire Disorder or HSSD. The benefits are an improvement in sexual function, mood and emotional symptoms.”
Testosterone is a male hormone but many women also have good circulating blood levels, which often decline during menopause. Testosterone replacement can help treat certain symptoms, including fatigue, loss of muscle tone and energy, reduced sex drive, low mood and brain fog. However, it should only be added once other hormones, particularly oestrogen, have been stabilised at optimum levels.
Testosterone treatment for women in the UK is off-licence and should only be prescribed by experienced specialists who have the ability to closely monitor blood levels and ensure that treatment is carried out safely within recommended parameters.
The British Menopause Society is campaigning for change, but that still looks like some time off. In the meantime, anyone considering testosterone therapy should consult an experienced and accredited menopause specialist, endocrinologist or specialist GP.
Menopause, incontinence and bladder health
Urinary incontinence affects more than 50% of postmenopausal women, with the number of women suffering increasing every year. Incontinence impacts self-esteem, quality of life and sexual function.2
Dr Shirin Lakhani, women’s health advocate and founder of Elite Aesthetics, said: “It is vital that the impact urinary incontinence has on women’s lives is more widely talked about so they no longer need to suffer in silence. Many women don’t even realise they have incontinence. They don’t understand that any involuntary loss of urine is incontinence. Their symptoms are often played down.
“The other aspect is that they are told it’s normal – it is part of having children or getting older, and it’s just something they have to get used to.
“The condition can be life-changing for some women. It can affect their social life and cause anxiety, depression and stress due to the worry and embarrassment associated with the condition. An overactive bladder can also affect sleep, as they may find they are waking up many times in the night to go to the toilet. It can make women feel like they have lost control over their bodies and could affect intimacy with a partner if you are worried about leaking during sex.
“In recent years, we have had all these amazing developments with non-invasive treatments that can really improve a woman’s quality of life, but the information doesn’t get to them. We need to start telling women that if it bothers them, it is something they can seek help for. It’s not something that just has to be brushed under the carpet.”
Genes and the menopause
Women’s genes can affect their hormonal health, menopause and reproductive life span. Researchers have found nearly 300 genetic signals associated with the age at which a woman enters menopause.
Experts in medical genetics also report that a woman’s DNA can significantly affect her symptoms during perimenopause and menopause.
Dr Mansoor Mohammed is a pioneer in medical genomics. He works with Dr Alessia Corrieri at the Precision Health Clinic to optimise health using knowledge of an individual’s genetic make-up.
Dr Mohammed states that the symptoms of menopause are different for women with different genotypes: “Using genomics helps us predict how women will experience menopause and how they will respond to treatment.”
It’s important to take each individual’s genetic profile into account before starting medications and other types of therapy to optimise women’s hormonal health.
Dr Corrieri said: “Before starting PHC and studying genomics, I utilised the normal NHS guidelines where all women are prescribed pretty much the same protocol irrespective of how their body produces or metabolises hormones. This approach also ignores the impact of other factors, such as insulin and vitamin D, on sex hormone regulation. Utilising knowledge of the patient’s genetics helps us produce a much more successful patient journey without the trial-and-error approach of generalised protocols.”
Menopause differences in ethnic minority women
Menopause is a significant health transition for women, influenced by biological, psychological, behavioural, and social factors. Despite the UK’s diverse population, there is limited research on menopause experiences in British ethnic minority women, with much information sourced from overseas studies.
In October 2023, the British Menopause Society published a report emphasising the importance of understanding the differences in biological and hormonal changes in women of different races and ethnicities.
“A better understanding of these similarities and differences will improve the delivery of culturally appropriate care that may help with symptoms and increase the quality of life for midlife women of all ethnicities and races.”
Different racial groups show variations in menstrual patterns and oestradiol changes at the time of menopause. In women of Afro-Caribbean origin, the mean age of menopause is 49.6 years. Women typically experience a longer duration of menopause transition, and they are more likely to suffer vasomotor symptoms, which tend to last longer and be more severe. In contrast, South-east Asian women are less likely to complain of debilitating vasomotor symptoms but may suffer from forgetfulness and musculoskeletal pain.
The mean age of menopause in South Asian women is 46.7 years, much lower than women in Western countries who experience menopause at 51 years on average. Premature Ovarian Insufficiency has a prevalence of 1.5% in this population, so it needs to be carefully considered.
In addition to the biological differences, ethnic minority women also face many challenges in accessing effective and appropriate menopause care. These include cultural stigmas, a lack of open discussions about menopause, and an expectation that women remain silent about their ailments. The lack of knowledge and awareness about menopause, coupled with language barriers, further complicates the situation.
The Oxford Menopause 2023 survey showed that non-Caucasian women and/or those of lower socioeconomic status are currently less likely to be diagnosed with menopause, contributing to large health inequalities and missed opportunities.5
Looking forward to 2024 and beyond, we can do better. We need to consider the differences between races, offer information in a culturally sensitive manner and provide resources in multiple languages to help all women transition through menopause and optimise their midlife physical, emotional and cognitive health.
Nutrition, supplements and nutraceuticals
Women are increasingly using supplements and nutraceuticals to optimise health, control symptoms, and take control of their personal menopause journey.
Registered dietitian Nigel Denby advocates for women to take care of themselves and look at the evidence behind the treatments. Nigel has specialised in supporting women through the menopause transition for over 25 years and is the author of 10 nutrition books.
He says: “Good nutrition is the cornerstone of good health. This is never more true than during perimenopause and menopause. Consensus grows daily that effective symptom management and a healthy diet and lifestyle are essential for menopause.
“The increased dialogue around menopause has seen a surge in product development to support this life phase. Many of the new products are little more than bandwagon jumpers. Two areas of interest which, with a little more robust evidence, could become more mainstream are CBD oil and collagen- watch this space!”
References
https://pharmaceutical-journal.com/article/feature/testosterone-for-menopause-why-women-face-difficulties-accessing-treatment#:~:text=On%2017%20February%202023%2C%20data,about%20the%20menopause%20in%202021
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528037/#:~:text=Urinary%20incontinence%20is%20the%20main,%2C%20urological%2C%20and%20sexual%20implications.
https://journals.lww.com/menopausejournal/abstract/2021/08000/genetic_variants_predictive_of_reproductive_aging.8.aspx
https://www.nature.com/articles/s41586-021-03779-7.epdf?sharing_token=Rei8159SsZ8QOdVtF8iZa9RgN0jAjWel9jnR3ZoTv0PS1-dNp_32UFksaZfcXaP3aXMkXALyAKO0nPcpbC39KeKlkBRzHI0ynfECm0hGGDLDphchLvY3DRC_
https://www.dovepress.com/getfile.php?fileID=94350
