Where's the evidence women will kill themselves without HRT?

Women must have HRT or they will kill themselves, campaigners claim… but where’s the evidence?

Is the menopause so horrific that it drives some women to take their own lives? It’s an alarming claim, often stated as fact – or, at least, it has been over the past few years.

Most recently, it was made by high-profile menopause guru Dr Louise Newson – a GP and founder of the private Newson Health clinic chain, which sees roughly 4,000 patients a month, all seeking treatment for menopausal symptoms.

A Mail on Sunday investigation, published earlier this month, revealed concerns about her clinic, which prescribes doses of HRT above the licensed limits to one in five of its patients.

Experts warned these high doses should be used only in ‘exceptional’ circumstances and accused her of putting patients at risk, as large amounts of some hormone drugs can increase the risk of womb cancer.

Dr Newson, on the other hand, insisted her approach helps vulnerable women who are struggling with suicidal thoughts.

High-profile menopause guru Dr Louise Newson has claimed the menopause so horrific that it drives some women to take their own lives. Pictured left to right: Dr Louise Newson, 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 in October 2021

A Mail on Sunday investigation revealed concerns about Dr Louise Newson’s clinic, which prescribes doses of HRT above the licensed limits to one in five of its patients (file photo of woman taking HRT pills)

She added: ‘The licensed doses are simply the doses the drug companies did their trials on.’

READ MORE: Celebrity menopause doctor who campaigns with Davina McCall and Mariella Frostrup accused of putting women at risk of cancer by prescribing ‘alarmingly high’ doses of HRT

 

After our report, Dr Newson – who is backed by celebrities such as TV host Mariella Frostrup – spoke to another newspaper about her stance.

The piece told the story of one woman who suffered a catalogue of mental health problems in her mid-40s that worsened. Antidepressants ‘made no difference’, but high-dose HRT helped. Dr Newson said that ‘a lot of women’ attending her clinic ‘have very negative intrusive thoughts that mean they feel like they’d be better off not being here’.

She added there was ‘no evidence that antidepressants help to improve the psychological symptoms of the menopause’ and that ‘HRT saves lives’.

So, is she right? First it’s important to look at the bigger picture: mental health problems are widespread. One in six adults suffer depression, and ten per cent severely. It’s roughly twice as common in women as it is in men. And some will be of menopausal age.

But does that mean menopause is the cause or the trigger? That’s quite difficult to answer – not that you’d know that from reading other recent headlines. ‘Women left suicidal amid HRT supply shortage as menopause ruins their life’ ran one, in April last year, reporting on the much-talked-about HRT shortages. Another simply said: ‘HRT life and death crisis.’

Most of these articles quoted campaigner and Labour MP Carolyn Harris, who said that women in her Swansea East constituency were ‘literally suicidal’ because they were unable to get HRT.

Meanwhile, Katie Taylor of the Latte Lounge, a menopause support group that charges £99 for annual membership, said: ‘It is no coincidence the highest rate of suicide among women is in the 45 to 55 age group [when most go through the menopause].’ But is it? The ONS, which gathers figures on causes of death, reported 5,583 suicides in 2021 – the most recent year on record. Three-quarters (4,129) were men, and the largest proportion of these deaths do occur in middle age (45 to 49 for women, and 50 to 54 in men).

And, obviously, men aren’t going through the menopause.

Mail on Sunday Health Editor Barney Calman

In women, the biggest increase in suicides has been in those aged 24 and under, while suicide rates for women 45 and older have dropped significantly since 1981. I did see a few articles suggesting there had been a rise in suicides in middle-aged women – a ‘fact’ that seemed to have been put out by a menopause campaign group. But this is not correct.

A key factor in what causes people to take their own life, according to the ONS, is socioeconomic status – suicide rates are twice as high in the most deprived areas, compared to the least deprived. And this gap becomes most pronounced in middle age.

Financial problems and debt, unemployment, relationship breakdowns and ‘the demands of midlife’ – caring for children and elderly parents – all play a role.

As Samaritans points out: ‘Most of the time there is no single event or factor that leads someone to take their own life.’ So could menopausal symptoms be one such pressure which tips some women over the edge? It’s entirely possible. But a single drug treatment, or the lack of it, is unlikely in such nuanced cases to make all the difference.

In its media guidelines for responsible reporting on suicide, Samaritans advises against speculating about a trigger or cause as ‘suicide is extremely complex’. Given this, the ‘women must have HRT or they will kill themselves’ rhetoric seems like a gross over-simplification.

Evidence suggests there is an average ten per cent increase in reports of depressive symptoms or low mood during the perimenopause – the transitional phase prior to the menopause, when hormones begin to fluctuate.

‘Just how much hormones play a role isn’t easy to unpick,’ says Kings College London’s Professor Myra Hunter, a psychologist with more than three decades of research into women’s health under her belt. ‘But symptoms such as low mood, sleep problems, stress and hot flushes can often interact in a vicious cycle, and have a serious impact on quality of life.’

This, explains Prof Hunter, is why NICE guidelines say HRT, which is highly effective in reducing all of these symptoms, should be considered for low mood in menopause, along with cognitive behavioural therapy.

Doctors are also advised against routinely offering women with menopausal symptoms antidepressants – unless they have a diagnosis of depression. ‘For depression, the type that might cause suicidal thoughts, antidepressants and cognitive behavioural therapy are proven treatments. And HRT can be used in combination with these if menopausal symptoms are a contributory factor.’

Labour MP Carolyn Harris (right with Lisa Snowden, left and Penny Lancaster in Parliament), said that women in her Swansea East constituency were ‘literally suicidal’ because they were unable to get HRT

In the 1980s, gynaecologist and HRT pioneer John Studd often treated women suffering mental health problems during the menopause with very high doses of HRT. His research also revealed a phenomenon called tachyphylaxis, in which some over-treated patients required ever higher doses to control their symptoms.

And some developed severe mental health problems as a result. So, clearly, more HRT isn’t always better for mental health. But, more to the point, Prof Hunter, like many others I have spoken to over the past few years, is concerned that a generation of women are absorbing the frightening messages that the menopause is going to be hellish.

Research suggests that these worries may make symptoms worse. In reality, most women do not have severe problems. But if they do, there is a range of evidence-based interventions that can help – not always HRT.

As Prof Hunter says: ‘There are many factors affecting midlife mental health. Hopefully we’ve moved on from blaming all of women’s problems on our hormones.’

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