We are pro choice but there is no choice for women in menopause
There's a lot of talk about menopause at the moment, and that's great, but why do we feel it's important to add our own voice and research to the conversation? The answer is simple - we are pro choice when it comes to managing menopause symptoms, but until now the choice for women is none at all.
The solution to date is a choice between drugs or no drugs. You will be offered one or a combination of HRT and antidepressants - it's not good enough and it also speaks to a wider issue that relates to women's wellness. At The Menopause Plus, we are here to provide an evidence based choice when it comes to managing menopause. First, however, let's look at the bigger issue - the gender gap when it comes to a right to health.
The gender gap in the right to health
This month, we attended the Global Wellness Summit in Tel Aviv, and what became abundantly clear during our time there was the confirmation of our own research and frustrations: women's health is being ignored. We all have a 'right to health' according to the World Health Organisation (WHO), except that women don't appear to have a right to health care that's designed for them.
This is an issue as old as time, going right back to Aristotle when the study of medicine revolved exclusively around male bodies - just attach the female ‘bits’ and you’re done. Today, not a lot has changed. Dr Kate Young, a public health researcher at Monash University in Australia, told The Guardian:
“For much of documented history, women have been excluded from medical and science knowledge production, so essentially we’ve ended up with a healthcare system, among other things in society, that has been made by men for men.”
She continued (this narrative will sound familiar for anyone who has had hormone issues in particular): “The historical hysteria discourse was most often endorsed when discussing ‘difficult’ women, referring to those for whom treatment was not helpful or who held a perception of their disease alternative to their clinician.”
40% of women experience sleep issues during menopause
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How gender bias manifests in healthcare
This gender bias manifests in very real ways in modern medicine. We see it in heart attack advice, which is largely based on male symptoms and therefore leave women more vulnerable (women present very differently); we see it in hormonal care (bad periods - take a pill, bad menopause - take a pill).
Women's minds and bodies are still not given the respect that they deserve. It's generally not coming from a space of wilful misogyny, but if a woman has a problem that could be related to her hormones or sexual health, there is a notable lack of empathy, followed by one of three broad solutions:
- Antidepressants
- Hormones (HRT or the contraceptive pill)
- Have a baby (I have heard this said multiple times to very young women experiencing endometriosis)
Gender stereotyping at the GP
It's not just about the understanding of hormones however, gender stereotyping has a lot more to answer for as well. For example, in the UK, as men are notoriously bad about going to the doctor when something's wrong, GPs are cash incentivised to roll out the red carpet and every test under the sun if a gentleman turns up with a sniffle.
However, if a woman turns up thinking she's losing her mind because her oestrogen levels are through the floor, she's invariably given a prescription for HRT without so much as checking her vitamin B levels (HRT can deplete vitamins B6 and B12, folic acid, and magnesium—critical for not only heart health but also mood).
90% of women experience symptoms of menopause
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All orgasms are created equal
Men and women might be equal, but they are certainly not the same - except, apparently when it comes to testing Viagra. It might interest you to know that Viagra for women is often tested on men. This curious nugget of information relates to Addyi, the first-ever drug to treat female sexual dysfunction. It was tested for adverse reactions to alcohol using a test group of 23 men and only two women. As Yale School of Medicine said: "that’s a population of 92% men for a drug intended only for women."
Perfect.
Menopause symptoms interfere with 85% of women’s lives
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Male mice are used in female drug testing
The gender bias doesn't stop with female drugs being tested on men - drugs are more often than not tested on male mice as well, and consequently they don't have the same impact on females. Step away for a moment from the animal testing issue - this in itself has created a systemic problem in women's healthcare. Northeastern University said:
"Many of these drugs don’t work as well for half of the population—that is, the female half. Women are also more often misdiagnosed for a variety of ailments, including stroke and ADHD. The root of this widespread public health inequity lies in mice and other animal research models. Up until very recently, the vast majority of basic science researchers used only male animals and cells in their studies. This has led to an incomplete understanding of how certain drugs work in both genders, and in some cases, dangerous health consequences for women."
‘Brain fog’ and memory lapses that result from a change in hormones
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Is 'female' pain less important than male pain?
To add to the list of things in which the world is experiencing difficulties, the NHS has been hit by a shortage of epidural kits to give mothers-to-be. In a challenge that has been described as prompting "difficult discussions" between hospitals and women, The Guardian reported:
"Supplies of epidural kits and the painkiller Remifentanil are now under such pressure that some hospitals cannot offer pregnant women their usual right to choose which one they want to reduce labour pains."
Aside from taking away a choice which we would consider to be a basic healthcare provision in a civilised world, this particular shortage begs the question: would things have been allowed to get this bad if men had to give birth? Labour pain is arguably the last accepted form of serious pain, and in any other context that level of pain would be non-negotiable. Something to think about.
Mood swings are a common consequence of hormonal change
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The speculum not redesigned since the Romans
Something that every woman over the age of 25 should be familiar with - that delightful instrument used for examining the vagina and cervix - the vaginal speculum - has remained unchanged since the 19th century, when it was designed by James Marion Sims, the controversial “father of gynaecology”. Actually, they're barely different to those used by the ancient Greeks and Romans.
One would like to think that's because it's such a perfectly designed instrument that it needs no improvement, but that's almost never the case with anything. As things happen, the speculum is now beginning to change as a team of female designers in San Francisco are looking to give the unfriendly implement a new design although it’s not available for the majority at the moment. It’s 1,000 years in the making though, so what does it matter if we need to wait a little longer?
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Contraception for women has barely evolved since sexual revolution
The Pill was the game changer that marked the sexual revolution in the '50s - women could get away from the home and pursue their careers, their sex lives, and anything else they wanted with greater freedom than ever before because they had greater control over their reproductive health. That's fantastic, but little has changed since then.
The contraceptive pill has been a game changer, but it's imperfect. Many women find that they experience side effects that are unacceptable - impacting their mental as well as physical health, especially now that we know more about hormone sensitivity. Furthermore, while there are other forms of birth control, The Pill still remains amongst the most prominent and lays the responsibility for contraception almost entirely at the door of women.
Research shows that only "one in three (33%) sexually active men would consider taking a male version of the pill". Meanwhile, "figures obtained by the Guardian under the Freedom of Information Act show almost nine in 10 women who receive contraception from the GP or pharmacies take either the combined pill or “mini pill” – a total of more than 3.1 million women in England in 2017-18".
We will just leave that information to percolate for a minute…
These are just a few examples of the discrepancies between the male and female experience of healthcare, highlighting that women's health is treated as secondary to men's. This difference is at its most acute when it comes to hormonal health. That's the reason we created MPlus and that's the reason we have launched The Menopause Million - we are redressing the balance. It's not just about talking about menopause - it's about offering evidence-based choices for women's healthcare to improve outcomes.
