10 Things We Learned About Menopause From Davina McCall
Both of the Channel 4 menopause documentaries, hosted by presenter Davina McCall, have been important pivot points in the ever-growing UK #menopause revolution.
But what bothered me about this 2022 documentary, Davina McCall: Sex, Mind and Menopause, and the first that screened in 2021, Davina McCall Sex, Myths and Menopause, was the sense of dissonance. On one hand they offer an overall mood of total disempowerment – women are losing it! We have to be rescued from this horror! – while showing a parade of people who did struggle but eventually figured out what works, whether it was cold-water therapy, an honest conversation with their boss, a meditation practice, or medication, and so on. Sort of like each of us have to do in every other part of our lives, until now.
Still there was a lot of important stuff in there, including the survey Channel 4 commissioned for the 2022 version, asking 4,000+ women about a variety of things: symptoms, menopause hormone therapy (aka HRT), symptoms, and their work situations.
Here are my 10 takeaways:
1) I’m always wondering: how many women actually take hormone therapy? According to the survey, as reported lamentingly by Davina: “79 percent never tried HRT, but of those who did more than 50 percent said it had given them their lives back”. This is such an interesting way to present the figures, because it can’t all be lack of awareness or accessibility, can it? It could very easily be this: ‘Our survey found just 21 percent of women had tried HRT, and only half stayed on it’.
2) Dr Paula Briggs, head of the British Menopause Society was on-hand to report that while many doctors are still reluctant to put women on hormone therapy during perimenopause to manage symptoms, it’s actually much better to start treating them earlier than later before they wreak real havoc and lead to job loss or relationship breakdown.
3) Dr Annice Mukherjee, endocrinologist, breast cancer survivor and leading hormone expert in the UK, was a living breathing advertisement for the non-hormone route. And the recipe for her path can be found in her highly recommended 2021 book The Complete Guide to the Menopause. Dr Mukherjee also talked about the potential emergence of a new non-hormone therapy for hot flashes, part of a class of drugs called NK3R antagonists that a number of companies are competing to bring to market; she says as early as 2023.
4) The documentary featured US Women’s Brain Initiative representatives Dr Lisa Mosconi (director) and Dr Roberta Brinton (collaborator) to talk about some of their most eye-opening research. They pointed out that scans show brain energy in perimenopause can drop by 25 percent; that explains brain fog, which 7 in 10 women reported experiencing according to the Channel 4’s survey. Dr Brinton adds to confusion about what is going on, at one point calling brain fog a “canary singing loudly in a coal mine” and another saying “menopause is like a renovation project on the brain”. So which is it? A very bad sign of things to come (loud canary) or a temporary situation (renovation project) where things are most likely to return to normal or even be better? (NB: Research supporting the latter hypothesis is the subject of neuroscientist Dr Louann Brizendine’s 2022 book The Upgrade: How the Female Brain Gets Stronger and Better in Midlife and Beyond.)
5) Testosterone can be an important part of a hormone therapy regime, particularly in cases of low libido and energy, although outside of the UK it largely must be used off-label. (This is such a mystery in 2022, as women make more testosterone than estrogen) As GP Dr Zoe Hodson puts it to Davina, our levels “dribble down” to about half by the time menopause is over, and if you decide to supplement, the benefits can include better focus, clarity, mood and finding our “mojo”. As for predictable fears about taking it, she says: “As long as it stays within normal female physiological range, we can discount the beards, we can discount the testicles.”
6) The British Menopause Society – in response to the second documentary – put out a statement reiterating that the current guidance is to prescribe menopause hormone therapy for symptom treatment, not to prevent future disease. And that includes dementia, which was specifically named. The US Preventive Services Task Force did the same thing shortly before). Even Dr Mosconi has said the evidence is promising, but not there – yet. Yet there was Dr Brinton, sitting right beside her, saying without hesitation that her research on the medical records of 400,000 women has turned up “substantial evidence that [bioidentical] estrogen and menopause hormone therapy can significantly, by 50 to 80 percent, reduce the risk of Alzheimer disease”. Hopefully in the future there will be some consensus on this point, and data to outline what risk reduction HRT provides on top of and in comparison to other lifestyle modifications.
7) One thing we know for sure, now: Exercise and a Mediterranean diet significantly reduce the risk of developing Alzheimer’s, said Dr Mosconi.
8) Dr Brinton, Dr Mosconi et al are developing a new plant-based treatment for hot flashes and cognitive decline. Their product-to-be, called Phytoserm, is a soy-based selective estrogen modulator.
9) A dire figure breathlessly repeated by UK media – that 1 million women are going to leave the workforce due to menopause – was busted down by the documentary’s own research. (And also brilliantly here by Magnificent Menopause’s Rachel Lankester). As Davina puts it in Sex, Mind and Menopause, the hidden scandal is that “thousands of women” will be forced to leave their jobs. In their survey, 44 percent of women reported having issues at work. A lawyer was on hand to report that menopause-related tribunals have tripled in the last three years, which the documentary called a “hidden system of shame and secret payoffs”, based on one anonymous case study. Menopause workplace policies, including a designated steward or representative to guide women, are relatively new. So the survey’s findings that 79 percent of workplaces don't have one aren’t really surprising: it’s a nascent field in HR, and the fact that one-fifth of UK workplaces have made these accommodations in a few short years is pretty remarkable.
10) Hormone therapy is a lifesaver for some women, and the impact can be immediate. The documentary referenced a teacher who, after losing her job, went to a doctor, got on HRT and felt better 48 hours later.