“Without understanding how it had happened, I had suddenly lost control of my emotions…”
“…somehow, entering my 40s had thrust me into a dark and unfamiliar world of mood swings, sleeplessness and suicidal thoughts…” shared Ursula Hirschkorn in a Telegraph article. Overwhelmed with the state of her emotions, Ursula consulted several different doctors, who all prescribed her with anti-anxiety and anti-depression medications, which did not make her feel better. This is a story we’re all too familiar with: antidepressants and the like being prescribed to treat menopausal symptoms. This problem is twofold: firstly, the tendency of doctors to prescribe antidepressants is on the rise, and secondly, the medical training on the menopause and menopause treatments needs improvement.
…overprescribing antidepressants is a general problem in the UK, one that deserves attention given the fact that antidepressants can have considerable side effects.
Let’s start with the first problem of doctors overprescribing antidepressants. Perimenopause and menopause is associated with many mental health symptoms such as depression, anxiety, and mood swings. So, without proper education on the menopause (which we’ll get to in a second) it can be easy to confuse the menopause with depression, bipolar and anxiety disorders. Many doctors in the UK and across Europe admit that we’re in a ‘prescribing culture’ – one in which antidepressants are prescribed quickly, without much consideration. In fact, according to The Guardian, many doctors expressed ‘frustration that limited time and even more limited resources mean that they often feel pressured to prescribe pills in less-urgent cases’. Overall, overprescribing antidepressants is a general problem in the UK, one that deserves attention given the fact that antidepressants can have considerable side effects. Additionally, the brain can build a tolerance for antidepressants, which can make them more and more ineffective in a long run, an important consideration given that menopausal symptoms can last for years and years.
So, on one hand, doctors are generally not well trained on the menopause, and on the other hand, women have been misinformed about available menopause treatments…
Now, while the menopause is associated with depressive symptoms, it is not the same thing as depression, so the treatment needs to reflect that difference. Why do doctors seem so unaware of the menopause and menopausal symptoms? The problem might trace back to 2002. According to Richard J Santen, president of the Endocrine Society, after the 2002 findings from the Women’s Health Initiative (WHI), which indicated that hormone replacement therapy (HRT) was harming women, prescriptions for it fell by 80% worldwide. On top of that, he explained, ‘medical training programmes began to overlook training new doctors how to care for menopausal women’. The WHI research has since been reanalysed and ultimately discredited, with newer reports concluding that HRT is quite safe. It’s old news: HRT is not significantly associated with cancer for most women (for more info, see our article on HRT and Cancer). So, on one hand, doctors are generally not well trained on the menopause, and on the other hand, women have been misinformed about available menopause treatments and are less likely to seek out HRT or ask the right questions about their symptoms.
Nonetheless, some advances have been made. The British Menopause Society has set up a Menopause Course aimed at nurses who regularly see and advise women on menopause. Additionally, they have created a training programme in conjunction with the Faculty of Sexual and Reproductive Healthcare, with various certificates of completion for GPs and gynaecologists. Still, menopause training needs to be better integrated into general medical training from the start of a doctor’s medical education, rather than a training programme on the side.
Currently, Meg is lobbying for a nurse practitioner in every GP surgery. Better and easier access to information on menopause is absolutely necessary. While antidepressants may be a solution for some, it is important to really understand the causes of your symptoms and the best available treatment for you.