Dr. Heather Currie MB BS, FRCOG, MRCGP is the founder and managing director of Menopause Matters Ltd., which provides information and support through its website menopausematters.co.uk and the quarterly magazine, Menopause Matters. Dr. Currie is an associate specialist gynaecologist based in Dumfries, with special interests in menopause, premenstrual syndrome and subfertility. She has run a specialist level menopause service in Dumfries and Galloway since 1993 and is a trustee and long-standing member of the British Menopause Society, serving as its chairman from 2016 to 2017. Lecturing nationally and internationally and having published many reviews and articles in peer-reviewed journals, Dr. Currie is the author of the books Menopause, Answers at Your Fingertips and Menopause Essentials, and also co-editor of Post Reproductive Health, the journal of the British Menopause Society (BMS).
Interview By Andrea Slivkova Photography By Menopause Matters
Dr. Currie, what initiated your drive to set up Menopause Matters?
While studying for MRCOG in 1989 when a Registrar in Obstetrics and Gynaecology, I realised how important menopause is and how much more should be done to provide advice and support. Having been appointed to a permanent post in Obstetrics and Gynaecology in Dumfries in 1992, I suggested to my consultant colleagues that we should have a menopause clinic in Dumfries, and this was opened January 1993. Over the ensuing years, as part of the menopause service and because there was much confusion around menopause and treatment options (and indeed still is), I wrote some information leaflets for women and one for healthcare professionals showing treatment options with practical prescribing advice. At that time, there were frequent changes with new products often appearing so updates were required.
While on holiday in late 2000, the time of the internet boom, my husband suggested developing a website to provide information which could easily be updated. Our return from holiday in early 2001 saw our area plunged into the distress of foot and mouth disease, with our beloved flock of pedigree sheep having to be slaughtered. The connection with Menopause Matters? Support was provided to help regenerate the area, and encouragement was given to explore the development of e-businesses. We received a grant to set up a new business, Menopause Matters. The website was launched in January 2002. With the recognition that there is still a huge role for print material and wanting to “glam up” menopause, the first Menopause Matters magazine was published in 2005.
Menopause Matters website receives between 8,000 and 11,000 visitors per day and content includes factual information, a forum, video links, surveys, the online magazine and an e-consultation option. Menopause Matters magazine print run is 12,000. Copies are sent to individual subscribers and are available in some GP surgeries, supermarkets and gyms. Costs are covered by advertising.
Our small team include webmaster Rik, advertising manager Annie, social media manager Therese and magazine editor Pam. Our aim is to continue providing accurate, up-to-date information, advice and support to women approaching and experiencing the menopause, in a range of formats. Our vision is that all women are able to make informed decisions about management of their menopause.
There are so many women struggling with their menopause symptoms and not being taken seriously by their doctors. Which issues do you feel need addressing urgently?
This is two-fold: women need to understand the menopausal process, what diet and lifestyle factors they can make to both reduce symptoms and improve later health and what treatment options are available. Secondly, education is needed for healthcare professionals so that women are given accurate and consistent advice.
With the British Menopause Society (BMS), of which I am a trustee and past Chair, many educational events and resources are available and we are working hard to implement the BMS vision for menopause care in the UK.
Can you sum up the commonly misunderstood issues around the menopause and the use of HRT?
1.“HRT just delays the symptoms and that you will have to go through this stage at a later date when HRT is stopped.”
In fact, HRT controls symptoms while present. If women choose to stop HRT at a later date, their symptoms may or may not be present. For those who still experience symptoms when stopping HRT, it is believed that they would have had symptoms all along if HRT had not been taken. We now know that the average duration of symptoms is 5 to 7 years and that many women still have symptoms in their 60s or later, so for some women, HRT may be needed for symptom control for many years.
2. “HRT can only be taken for 5 years.”
There are no arbitrary limits to the duration that HRT can be used. As mentioned, symptoms can go on for many years. We can never predict how long symptoms can last and therefore cannot predict how long HRT will be required for symptom control. The type of treatment used and duration should be individualised – we are all different. HRT can be used for as long or as little a time that each woman feels that the benefits outweigh the risks to her.
3. “HRT causes breast cancer.”
The association of any HRT and breast risk is very small. Estrogen-only HRT is not thought to be associated with an increased risk of being diagnosed with breast cancer. Estrogen combined with progestogen may be associated with a small increased risk of being diagnosed if taken for more than 5 years after the age of 50, (approximately extra 4 cases per 1000 women aged 50-59 over 5 years) but these extra cases are thought to be due to HRT promoting the growth of cancer cells which are already present, not actually causing the cancer.
Many women and healthcare professionals have worried for years about this risk and while it is important, it needs to be kept in perspective. Being overweight is a bigger risk! Also, the breast risk from HRT which was highly publicised from the WHI trial published in 2002, was not in fact statistically significant.
Doctors and consultants are still divided into pro-HRT and anti-HRT. While such division can be understandable in the layman population, it seems a little extreme among professionals. What is your view on this?
The publication of the WHI trial in 2002 with massive emphasis on the risks of HRT, which have since been found to be hugely exaggerated, still influences the view of many healthcare professionals. Not all have a special interest in the subject and therefore are not aware of important recent guidelines and recommendations, such as the NICE guideline on diagnosis and management of menopause, which recommends that HRT is the most effective treatment for menopausal symptoms, and should be offered first line.
We at Menopause Matters and British Menopause Society still have much work to do so that women are given consistent advice and can base their decisions on accurate information.
Private menopause specialists have waiting lists 2 to 4 months long, and with appointments costing approximately £200, it shows a staggering number of women desperate for help with managing their symptoms. Should women get on a private menopause GP waiting list or persevere with their own NHS GP who may not be very forthcoming with prescribing HRT?
The BMS vision aims for each GP practice to have someone with a special interest in menopause, and that there will be a Specialist NHS service in every region in the UK. Meanwhile, it is really important that women seek information from reliable sources and have an informed discussion with their GP.
There will be a map of BMS recognised Menopause Specialists published on the BMS website that Menopause Matters will link to, launched on World Menopause Day this year (18th October). Women can ask to be referred to one of these clinics. We have had examples of women being able to educate their GP by having informed discussions using information from Menopause Matters, which is fantastic.
Many GPs around the country are very experienced and most women can access excellent care from their GP, especially if they have a special interest in menopause. Practical resources are available from the BMS to help GPs and Practice Nurses.
Some women with complex history, or poor response to treatment may require referral to a specialist, and some will choose to attend a private clinic, but most care should be provided through the NHS.
Do you feel more doctors, GPs and consultants would benefit from joining The British Menopause Society, and from the training and support it offers?
Menopause affects all women in many different ways, and the consequent lack of estrogen can affect many bodily systems. The BMS vision states that all healthcare professionals should have a basic understanding of menopause and the consequences of estrogen deficiency. If these are not recognised, many women may undergo unnecessary tests, be given inappropriate treatments and incorrect advice.
The Menopause Matters forum has an impressive list of UK based clinicians who are all experts in the field of menopause management. How do they contribute to the website, forum and advice?
The clinicians listed helped with content initially, and provide updates. Professor Grant Cumming is our lead in research in that we have had many publications from results of online surveys. These have been incredibly helpful in highlighting areas in which more education or support is required. We regularly have many responses to our surveys.
Many women subscribe to individual copies and subscriptions can be taken online or by post. Details are available at www.menopausematters.co.uk/magazine.php
In addition, free copies can be picked up in some GP surgeries around the UK, as well as some supermarkets, gyms, airport and cruise terminals. Finally, the magazine can be seen online, where the current issue as well as previous issues and selected articles are available. We continue to investigate ways to increase access for women across the UK. I would love it to be available in every branch of a well known store or supermarkets!
I understand that anyone can access your advisory service via email in regards to their menopause and HRT. What information should be included?
It is really helpful to provide a summary of history, current medication and current problems. The response should not be considered as a replacement for a consultation with your own doctor, but hopefully it will be helpful in providing useful information. I sometimes ask for further information to clarify an aspect but reply to provide more information does not incur a further charge. Fees from online consultations are used to help cover the costs of website running and development, and magazine publication.
Write to Dr. Currie via www.menopausematters.co.uk
Womens’ Health Concern, patient arm of the British Menopause Society
What is menopause?
As formally defined by the British Menopause Society, the menopause is the permanent cessation of the menstrual cycle, that results from loss of ovarian follicular activity. Natural menopause is recognised to have occurred after 12 consecutive months of amenorrhoea (absence of a menstrual period in a woman of reproductive age) for which no other obvious pathological or physiological cause is present. Menopause occurs with the final menstrual period so is only known for certain in retrospect a year after the event.
Premature menopause, or premature ovarian insufficiency, is frequently defined as menopause that occurs before the age of 40 years. In the developed world, it is thought that it should be defined as menopause before the age of 45 years, the loss of estrogen having particular long term health risks in this age group.
A frequently quoted figure for women experiencing premature ovarian insufficiency is 1% , although some feel that the actual figure is higher.
Early menopause is a menopause that occurs between 40 and 45 years of age.
Younger women with a sudden cessation of ovarian function may experience a sudden drop in estrogen and more severe symptoms.
A sudden menopause in young women is usually experienced as a result of treatment such as radiotherapy to the pelvis or chemotherapy, or if the menopause is surgical, (i.e. the ovaries are removed). In these situations, higher than standard dose of estrogen may be needed to control symptoms.
Women who experience premature (under the age of 40), or early menopause (under the age of 45), are advised to take HRT, whether or not they have menopausal symptoms, at least until the average age of the menopause, unless there is a contraindication to HRT. This is because HRT reduces the increased risk of long term problems associated with untreated early or premature loss of estrogen, such as osteoporosis and cardiovascular disease.
There are concerns that ovarian function can be suppressed as a result of heavy training.
Symptoms of menopause can include hot flushes, night sweats, palpitations, insomnia, joint aches, headaches, dry skin, dry hair. Psychological symptoms may also be experienced including low mood, anxiety, irritability, mood swings, lack of energy.
Treatment: Because the hormonal changes of the menopause affect every woman differently, we need to work out how best to manage these changes. While we are all unique, attention to diet and lifestyle at this stage is important since the later effects of the menopause and estrogen deficiency can be helped by adopting as healthy a lifestyle as possible.
When it comes to considering specific treatments, these include Hormone Replacement Therapy, and other prescribed treatments, alternative therapies and alternative techniques. Being aware of the treatment options will help you decide what route to take and will assist in preparing you to discuss your symptoms further with your doctor or nurse to make an informed choice.
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