Any steps towards inclusivity in societal & cultural terms are cause for celebration but in medicine, that can come in the form of a ‘diagnosis of inclusion’, the opposite, of course, of a ‘diagnosis of exclusion’ and potentially as slippery and loose as it sounds. That’s the somewhat precarious position we find ourselves presently in with perimenopause and menopause. With greater recognition of just how long health effects can kick in before there are any cycle changes [2-12 years for those of you playing along at home] and the widening lens now taking in the diversity of such health effects, women’s health has had a win. But, I would argue, this is not without a double edge. After all, aren’t we, as a result, more at risk, as women, of having everything attributed to “just ‘the change’, love”, and, in turn, going to be offered sex hormones more often as the solution?
And I am not alone in my thinking on this.
Just after recording my latest Update in Under 30 episode titled: Menopause: Missed & Misdiagnoses part 1 [you bet there are 2 parts there is a LOT being missed peeps!] I stumbled across a LinkedIn post by UK GP & Sexologist Dr. Angela Wright singing from the same songbook! Her post on this issue [see fabulously provocative image above – which was immediately followed by the words: No, I don’t actually think that], implies that we risk making an unwelcome return to some very black and white thinking: all women, following their ‘best before date’ are deficient in sex hormones and this explains all their ‘issues’. Likewise, a lot of the comments that followed, many from GPs noted the ‘swinging of the pendulum back towards and in favour of MHT’. 🤦♀️ Treatment tunnel-vision aside, I want to circle back to (peri)menopause now being pitched as a diagnosis of inclusion – which runs the very real risk that other pathologies have not been sufficiently excluded. And as a consequence, there is both a parallel pathology running unchecked along with heightened risk of the biggest diseases for menopausal women, anyway, and MHT or any other specific menopause oriented prescription, will not alleviate their anxiety, nor stop their sweats, nor solve their sleep because, (peri)menopause was only part of their story!! Aha. That’s what I am talking about. these missed diagnoses do some great menopause mime work..so good, many of us, can’t seem to spot the difference. 🤦♀️🤦♀️
Several medical conditions peak at the same age and stage as (peri)menopause in women, and to add to the confusion, many of their signs & symptoms overlap with those that might be solely attributed to these reproductive stages. This means that they are frequently missed or misattributed leaving many women to have incomplete resolution of their distressing presentations and unacceptable unchecked elevated risk of osteoporosis, cardiovascular & metabolic & neurodegenerative disease. This first episode covers hyperparathyroidism and hot nodules and includes a great desktop resource summarising key overlapping features & easy accessible ways to confirm or exclude these in your patients.
You can purchase Menopause: Missed & Misdiagnoses Part 1 here. If you are an Update in Under 30 Subscriber, you will find it waiting for you in your online account. You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.