The EconomistDecember 14th 2019 511I
t was acombination of things. An un-
usual feeling of depression. Constant
forgetfulness. An irregular menstrual cy-
cle. Lucy, a British woman in her early 40s,
knew that something was wrong. Two
years before she had been training at the
gym five times a week. Now she could bare-
ly find the energy to exercise at all thanks to
chronic insomnia, a new affliction. Her de-
meanour had shifted from one of cheeri-
ness to constant anxiety. Her work and her
home life were suffering as a result.
Unsure what was causing these
changes, she visited her doctor. The phys-
ician blamed stress. She suggested Lucy re-
turn in a year. Frustrated, Lucy turned to
the internet. Her research led her to believe
that she was entering the transition into
menopause. Menopause is the time in the
middle of a woman’s life—which can begin
in the early 40s—when her levels of hor-
mones such as oestrogen, progesterone
and testosterone plummet. This eventual-
ly causes her ovaries to stop producing
eggs and her periods to cease. After a year
without periods, a woman is considered tobe menopausal. The symptoms of meno-
pause can include hot flushes, depression,
aches and pains, insomnia, anxiety and
transient memory loss.
Lucy’s experience is unremarkable in
two ways. First, every woman experiences
menopause. Second, doctors all over the
world often fail to provide them with treat-
ment that could alleviate their symptoms.
Research suggests that 70-80% of women
experience symptoms and for just over a
quarter they are debilitating. On average
they last for seven and a half years.
And yet doctors often encourage wom-
en to grin and bear it. Some suggest eating
well and exercising more, which may ease
the symptoms. Some prescribe antidepres-
sants or anti-epileptics, which do not treat
the cause of the problem. A cheap, effective
alternative exists: hormone-replacement
therapy (hrt). But as a result of misinfor-
mation and scaremongering, millions of
women are missing out on it.
Menopause harms women’s bones,
brains, hearts and immune systems. It is
associated with a higher risk of osteoporo-sis and fragility fractures, increased ab-
dominal fat, and a heightened risk of con-
tracting diabetes, explains Susan Davis, a
professor of women’s health at Monash
University in Australia.
The hormonal changes of menopause
also seem to make women age faster. They
speed up cellular ageing by about 6%, when
age is measured by the genetic changes in
the blood. It is suspected that the insomnia
associated with menopause could be caus-
ing this. Oestrogen is particularly impor-
tant in maintaining the health of women’s
hearts. Before menopause women have
fewer heart attacks than men. After meno-
pause the risk increases as the elasticity of
the coronary arteries decreases along with
their oestrogen levels.By pill or by patch
In 1966 Robert Wilson, a doctor, wrote a
book called “Feminine Forever”. In it, he ar-
gued that women’s loss of hormones after
menopause give rise to a serious, painful
and often crippling illness, known as oes-
trogen-deficiency disease. A regular course
of oestrogen supplements was the sol-
ution, he suggested. They would preserve
women’s youth, sex appeal and marriages.
The book was divisive. Some women
embraced taking oestrogen as a way to de-
feat the ravages of time. Others resisted
what they saw as an attempt to pathologise
a natural stage in a woman’s life. Nonethe-
less, by the turn of the millennium hor-
mone-replacement therapy was extremelyMenopauseThe time of her life
Millions of menopausal women are missing out on the benefits of
hormone-replacement therapyInternational