There is considerable confusion about hormone replacement therapy for a variety of reasons. In the past, very little good research was carried out on this topic, partly because no one has ever died from the menopause; and because most medical research is concerned with wider, life-saving issues. The situation is altering now because there is a more enlightened attitude to the effect of well-being on the woman, her family, and the community generally.
Confusion has also been created to some extent by the media. How can a reporter be expected to sort our medical detail? The media has often confused the issue just as the whole situation was becoming clear. The current confusion has made doctors afraid to give therapy, and women afraid to accept it. Some people are now being unnecessarily deprived of relief because of fear of the side-effects.
Some women need no help at this stage, others need it for a few months or a few years, or recurrently as the symptoms recur, and a few women need it for life. Some women who come into the clinic do not come back because they are urged to get off hormones either by their family or by their own consciences after reading press articles. Some people dismiss the whole business of menopause as a state of mind, and tell these women to pull up their socks and get on with it. In one survey carried out in our clinic, a high proportion of women who had complained of treatable symptoms had been told that they were menopausal, given a prescription for a tranquilliser and dismissed. On the other hand, there was a vogue in the 1960s in the United States for putting all women on oestrogens after the menopause, as it was regarded as a deficiency disease, much the same as diabetes. This vogue did not reach Australia to any extent.
We know it is not wise to give oestrogen to all women. For some, in whom oestrogens are contraindicated, it could even be dangerous. In addition they have side effects. Also, oestrogens do not reverse the ageing process, as some hope. They only alleviate symptoms which are oestrogen dependent.