Menopause: I admire Davina McCall but I didn't want to be a crusader

More selfishly, perhaps, I didn’t want to be defined by it. I know what happens when you start opening up about “women’s problems” and particularly about mental health: you become a talking head, one of the go-to people on the subject.

Every time a news story breaks, you’ll be asked to add your tuppenceworth, and I had other, more interesting things to be getting on with.

I had nothing but admiration for Davina McCall and the other crusaders who led the charge in raising awareness of the benefits of HRT, but, at that point, I wasn’t on it, and I didn’t want to be one of them.

Davina McCall is a prominent campaigner for HRT 

In any case, I lacked their certainty. I never suffered from hot flushes or night sweats, so I wasn’t clear if what I was experiencing - intense anxiety, insomnia, depression - was caused by falling levels of oestrogen, or stress, a sense of panic over time running out and a predisposition to catastrophising.

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I know other women have different experiences of the NHS; but my GP was kind and proactive. She prescribed antidepressants (because that’s what I asked for) and, eventually, a short round of CBT, which I found too generalised to be of much use, but at least provided a safe space to talk. Much later, still prone to anxiety attacks, I started HRT.

I believe it helps, though, equally, I am prepared to accept it may just be that I got better. Either way, for me, it seemed worth the health risks, which I understand to be minimal; if that ever changes, I will come off it.

Lancing the Lancet?

That I am writing about my experiences now is down to a series of articles and an editorial in The Lancet. These articles, which are quite detailed and technical, have, in turn, prompted a media backlash criticising the “sensationalising” of the menopause by celebrity campaigners and its “over-medicalisation” by commercial interests which have “appropriated feminist narratives of empowerment”.

That The Lancet’s work has itself been spun should come as no surprise. The Daily Mail, for example, quotes experts suggesting the celebrities’ “horror stories” are leaving women “scared about what is a biological inevitability” underneath a cross-reference to another story: “Is your brain fog down to the menopause….or DEMENTIA?” This cross-ref is the very definition of sensationalism, and far scarier than anything I’ve ever heard Davina McCall say.

The original articles are more measured, and convincing up to a point. I can see, for example, that it may be counterproductive to treat the menopause as a “disease”; that it would be better if GPs recognised it as the product of both physical and environmental pressures - a messy mix of hormones and heartache. In a world where women continue to bear the brunt of raising children, it can be devastating for them to discover that - at precisely the point they are ready to rebuild their careers - they are struggling to cope with what their mothers referred to as “the change”.

Perhaps they also have elderly parents in need of care. Or their marriage is under pressure. Or - alternatively - perhaps they are having to come to terms with never having children. All those problems, which may also apply to men, are more difficult to cope with if your day is punctuated by hot flushes, and you can’t sleep at night.

The Lancet calls for a more holistic approach. It points out not all women suffer symptoms, and says it is damaging to present them as inevitable. It criticises the marketing of HRT as a panacea, pointing out many women can’t or don’t want to take it. And it calls for “a sensible conversation about menopause to enable informed, individualised decision-making on optimal management of this transition.”

Mariella Frostrup, MP Carolyn Harris, Penny Lancaster and Davina McCall with protesters outside the Houses of Parliament in London demonstrating against ongoing prescription charges for HRT (Hormone replacement therapy)

Taking control

On one level, none of the above seems unreasonable; and yet there is, throughout, an underlying tone of dismissal, a diminishing of women’s ability to take control, a positioning of the menopause as a First World problem, and a pull-yourself-up-by-the-boot-straps mentality that becomes more offensive the more you reflect upon it. Take that phrase “sensible conversation.” Because, what? Because the conversation up until now - the conversation led by McCall, Kirsty Wark, Oprah Winfrey and Michelle Obama - has been hysterical and we are relying on The Lancet to calm us all down?

One of the papers - the one most relevant to me - reviewed “12 studies prospective studies reporting depressive symptoms or a major depressive disorder or both over the menopause transition and found no compelling evidence for a *universal* increased risk for either condition.” (Did anyone ever suggest the increased risk was universal?)

It went on to suggest that the “misattribution” of psychological distress could harm women by “delaying accurate diagnosis” and creating negative expectations for people approaching the menopause. This seems perilously close to saying that the low mood women report time and time again is a contagion - like tics on TikTok; or that it is a self-fulfilling prophecy based on absorbing other people’s accounts of their own experiences.

On top of being patronising (middle-aged women, so suggestible, bless ‘em) the article carries a danger all its own: that GPs, who were only just beginning to take on board the complexities of the menopause may read it and go back to dismissing depression as a potential symptom. That’s the ones who accepted it as such in the first place. I know, through friends, that women are *still* being told HRT has no effect on low mood, only to insist on a prescription, and discover it works wonders for them.

It is the campaigners who have empowered women to challenge their GPs, and that has come at a cost. The Lancet points out pharmaceutical companies have a vested interest in promoting demand for menopause-related medicines. But it ignores the fact the medical profession has a vested interest in dampening that demand down, given rising HRT prescription bills and the shortage of the safer, body-identical product which more and more women are now aware of. It is interesting, this sudden advocacy of alternative approaches (although I doubt the NHS could cope with a sudden upsurge in demand for CBT either).

Extreme symptoms

Another issue The Lancet touches on is whether employers should be required to make adjustments for women suffering extreme menopause symptoms, as the Equality and Human Rights Commission recently suggested.

“Interpreting the menopause more broadly as a disability risks further fuelling the ageism and stigma that older women already face,” that particular paper says; and I get it.

If I’m honest, I didn’t tell anyone what I was going through for the same reason, years earlier, I didn’t put photographs of my children on my desk: I didn’t want to draw attention to something likely to be perceived as a weakness. But I see now that keeping quiet only reinforces the stigma. If women are reluctant to discuss their symptoms then - it stands to reason - those symptoms must be something to be ashamed of.

And so I am grateful to all those high-profile figures who have talked openly about the menopause and the power of HRT.

Sorry if it bores some men; sorry if it places more pressure on the NHS, but McCall et al have done women a great service by encouraging them to push for whatever treatment they believe will help. They deserve better than to be dismissed as “celebrities” with “horror stories”. And The Lancet’s series would have packed more of a punch if it had acknowledged their contribution.