Why paying £99 to find out if you’re menopausal is a waste of money… and the problem is we haven’t put enough resources into high- quality research writes DR MARGARET McCARTNEY
Less dementia, better teeth and more sex — and an end to hot flushes, of course.
The lectures I attended about hormone replacement therapy (HRT) as a medical student — more than 25 years ago — sold it as gold.
Then came the Women’s Health Initiative Study in 2003, which seemed to show that HRT caused a rise in cancer and heart disease risk, not reducing the danger, as we’d been told.
There was a furore: prescriptions plummeted, even though subsequent studies and re-analyses of data overturned those findings.
But thanks to huge media attention, the past few years have seen an upsurge in the popularity of HRT, with a doubling in prescribing in England in the past five years.
And in this surge, multiple companies have also sensed an opportunity.
Superdrug has just launched what it describes as ‘the most comprehensive perimenopause health screen service on the High Street’.
Yes, your GP can offer you this test, but is unlikely to do so. That’s because hormones fluctuate wildly, writes Dr Margaret McCartney (pictured above)
It’s not alone. Dozens of private clinics are offering ‘women’s menopausal assessments’ and ‘midlife MoT’ designed for women around 50 who are in the perimenopause (the time leading up to the last period) and the menopause.
So should we all be signing up to Superdrug’s offer ‘to support people who are experiencing symptoms such as hot flushes, night sweats and erratic menstrual flow and [who] want to be taken seriously when facing health issues potentially connected to the menopause’?
First, only women — females — can have a menopause. Second, I’d argue these blood tests are unnecessary for the vast majority of women. The High Street ‘screen service’ looks at levels of three female hormones (oestradiol, the follicle stimulating hormone FSH, and luteinising hormone LH, which helps to control menstruation) as well as checking levels of thyroid hormone, cholesterol, vitamin D, calcium and magnesium.
Now, in women with suspected early menopause — before the age of 45 — or where there’s a concern about something else going on, there is certainly a role for blood and/or other tests.
But the guidance from the National Institute for Health and Care Excellence (NICE) is very clear: ‘do not use’ the FSH hormone blood test to diagnose menopause, which instead can be diagnosed ‘without laboratory tests in otherwise healthy women aged over 45 years with menopausal symptoms’.
So yes, your GP can offer you this test, but is unlikely to do so. That’s because hormones fluctuate wildly.
If a woman is still having erratic periods, all that the hormone test will do is tell you you’re having erratic periods — they reflect the hormonal fluctuation that is causing that irregularity. The hormonal blood test is too hit and miss to be reliable.
The problem is we haven’t put enough resources into high-quality research into women’s health over many years, and this means the evidence for HRT is still not as reliable as it could be. A file photo is used above
And while thyroid blood tests can be helpful if thyroid disease is suspected, it’s not needed just because you are menopausal.
As for vitamin D — again NICE says ‘routine monitoring . . . is not needed’ for adults in general — nor is checking calcium and magnesium levels recommended for healthy people as an MOT.
Instead, the advice is that everyone considers taking a vitamin D supplement during winter at least. Otherwise, a balanced diet should contain everything you need.
As for cholesterol, women can already get this tested via the NHS: in England, a health check is offered to everyone over 40. And while Superdrug doesn’t include a blood pressure check, the NHS does — arguably more useful. But while nutrient checks are unnecessary, the real point is that a blood test for hormones doesn’t necessarily mean that those hormones are the cause of every symptom a woman experiences.
What matters is looking at her symptoms and considering the menopause as a potential cause of them, but not excluding all other possibilities either.
To be fair to Superdrug, it does say that blood tests aren’t always needed, and that seeing ‘normal hormone levels in someone with menopausal symptoms does not rule out the perimenopause, and as such it is important to discuss your symptoms with your doctor if you have any concerns’.
But, of course, this means your NHS GP then has to deal with test results they themselves wouldn’t have ordered — and women have paid for tests in the meantime.
Yet at £99, this is a lot less than what private clinics are offering— and charging. Bupa, for instance, has a ‘menopause plan’ with check-up appointments spread over a year at £250; some private hospitals claim that their menopause clinic, with breast and pelvic examinations with a doctor are ‘among the most important things you can do for yourself’ — with the suggestion that serious diseases can be picked up earlier.
But there’s no evidence that seeing a doctor for a regular breast or pelvic examination can improve health outcomes.
Clearly, if a women has symptoms — a breast lump or unexplained vaginal bleeding or discharge — she needs medical advice and investigations.
But as a routine, in a well woman without symptoms? There is simply no evidence that breast and pelvic examinations, or hormone blood tests are necessary for good menopause care.
Doctor Ink
The tattoos being used for medical purposes. This week: To cover up hair loss
A tattoo to mimic hair can be a safe and cosmetically effective way to help people with hair loss or alopecia, reported the Journal of Craniofacial Surgery last year.
In a study in Turkey, 16 men and six women underwent scalp micropigmentation procedure (SMP) in three weekly sessions with a final touch-up appointment a month after the last session.
There was minimal fading after 20 months and 100 per cent of the women and 80 per cent of the men were happy with the results. Only one patient had an allergic reaction.
SMP can also be used to cover up any type of scalp scars.
Instead, it really is the basics that matter for prevention of future disease — a balanced diet, exercise (especially bone strengthening, weight-bearing exercise — walking, dancing, running or netball), enough sleep and keeping your weight reasonable (plus not smoking or drinking excessively).
A key offering of private clinics is, naturally, HRT — and like all medication, it has pros and cons.
The problem is we haven’t put enough resources into high-quality research into women’s health over many years, and this means the evidence for HRT is still not as reliable as it could be.
For example, while the evidence that it helps flushes, sweats and bone health is strong, there’s not detailed enough information about what aspects of quality of life are likely, or not, to be improved by HRT.
This can mean that other influences on prescribing come into play — especially drug companies, who pay opinion leaders for consultancy, advice, lectures or writing educational material, which in turn influences other doctors.
When I’m looking for clinical advice, I want it to be as independent as possible.
It’s fair to say previous scares about HRT were overstated, but there are also some claims currently being made for HRT which go beyond the evidence.
It’s very likely to help with hot flushes and night sweats, and protect bone health. But some clinics list masses of symptoms that they claim can be helped by HRT — from fatigue and palpitations to reduced confidence.
And, yes, some women may report an improvement in all sorts of symptoms with HRT, but others won’t (even with high doses).
For example, a study published in the BMJ in 2008 showed that HRT, overall, helped with hot flushes, sweats and sleep problems, but didn’t with depression or anxiety.
That may be because it’s a symptom of the menopause which is not responding to HRT, or it could be that the low mood experienced isn’t caused by it.
Women need all-round holistic care — where all possibilities are considered — not assuming that every symptom is caused by menopause and needs HRT.
Of course, not everyone giving advice has a financial conflict of interest, and drug companies do need to work with doctors to get good products on the market.
But I’m cautious about enthusiastic claims made by those who stand to benefit from more prescribing of HRT.
I often recommend the NICE website for women to look up the detail on the risks of HRT.
Overall, these are very low, but it’s really up to the woman to decide whether she agrees, especially when put against how useful it is for the menopausal symptoms she’s experiencing.
The sting in the tail is that the attention given to the menopause may have a positive effect in stimulating better research or useful interventions for women — but it’s also opened a door to a new industry selling us (often expensive) stuff that we don’t need.
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