Nicolás Mendoza Ladrón de Guevara
Professor of Obstetrics and Gynaecology at the University of Granada, president of the Spanish Foundation for the Study of the Menopause (FEEM) and member of the Board of the European Menopause & Andropause Society (EMAS)
These articles are written in a high-impact journal by opinion leaders and make many menopause-related issues visible, most of them with a positive outlook. To sum it up in one paragraph: that menopause is a transitory state in women's lives that begins with ageing and is mostly accompanied by mild symptoms that do not need to be treated. However, a percentage of women undergo this transition with severe, persistent symptoms and its long-term consequences can lead to some medical disorders (cardiovascular diseases, osteoporosis, etc.). Another smaller percentage of women will have 'early' menopause as defined by its authors (before the age of 45) and in these cases they should be given medical attention. When it occurs before the age of 40 (premature ovarian failure or early menopause) it is considered an endocrine disease requiring hormonal treatment.
Although they are articles written by opinion leaders, they are narrative reviews, a model for scientific publications with limitations that include individual opinions. Those of us who are also opinion leaders (I myself am the international representative of Spanish menopause specialists) say that "opinion should be separated from medical decisions". Thus, articles reflecting medical recommendations should be 'Clinical Practice Guidelines' based on systematic reviews.
Like many scientific publications fraught with publication bias, they are written by Anglo-Saxon [authors] (USA, UK, Australia). In the Anglo-Saxon world of extreme liberalism, menopause is an impairment of job performance: this is further stigmatising women.
The link between hormone therapies and breast cancer is, to say the least, contradictory. If the link between hormone treatments used in the Anglo-Saxon world and the risk of cancer is accepted, it is clinically insignificant and comes from patients who have been given them without indication, apart from being obese and above 60 years of age on average. Using other types of hormone therapy, in women under 60 without obesity and when indicated, no such relationship has been observed in European countries.