The Queenager | Eleanor's Letter

I meet Davina who's back with a new menopause doc – and some big revelations.

It’s been quite a week! On Monday I interviewed Minnie Driver (coming out on Noon soon, watch this space) and then popped down to the cinema at Selfridges for a very glossy preview of the next Channel 4 Davina McCall documentary on menopause. This one is all about the links between hormone deficiency in menopause and what happens to the female brain – and I was gobsmacked. (And yes Davina looks as fab in the flesh as she does on screen, rocking cowboy boots and bare brown legs, without goosebumps even though it was freezing! She was sitting next to me at the do, so take my word for it).

The title of the new show which went out on Channel 4 on Bank Holiday Monday (and is still available for catch-up) is Davina McCall: Sex, Mind and the Menopause and it focuses on what is happening in our brains during this period.

As many of you will know Alzheimer’s is the main cause of dementia, and the incidence of Alzheimer’s in women is double that of men. Yes, that is correct, women are twice as likely to get Alzheimer’s as men are. For a long time, this was thought to be because women live longer than men, and the older you get the more likely you are to lose your marbles. But new science from the US (peer-reviewed proper science, honest) shows that as Dr Lisa Mosconi of the Women’s Brain Initiative puts it: “Women’s brains are not the same as men’s brains. Female brains age differently from men’s. I started to look into that because I have a family history of Alzheimer’s disease.”

(If you want to check her out for yourself she is the author of New York Times Bestseller The XX Brain and is on Instagram as @dr_mosconi)

What Dr Mosconi discovered led me to a truly life-changing moment. Dr Mosconi and her partner Dr Brinton (both of whom talk about their research in the documentary) conducted an observational study of the medical insurance records of 400,000 women in midlife and beyond. Their stunning finding was that those treating their menopausal symptoms with HRT had a dramatically lower incidence of Alzheimer’s. “There is substantial evidence to indicate that oestrogen and hormone therapy can significantly reduce the risk of developing Alzheimer’s – by 50 to 80%!” says Dr Brinton. That is a huge statement. So massive in my book that I nudged Davina who was sitting next to me and said in a loud stage whisper: “That should be on the side of every bus in the country!” To which she nodded vigorously.

Of course, as with everything medical, there are caveats. It is still true that women who have had breast cancer or are at risk of it cannot take HRT as the oestrogen elevates the risk of cancer returning. And in the interests of balance, it is important to note that some historic studies found taking combined HRT in later life could increase dementia risk (notably the Woman’s Health Initiative study in 2002 which also said there was an increased risk of breast cancer which has now been widely discredited but was the reason why a whole generation of women was put off taking HRT).

But the key import of Dr Mosconi and Dr Brinton’s work and study is that taking body identical oestrogen early – i.e. in perimenopause, or around the time of menopause – seems to protect the brain against future dementia (they’ve got lots of good brain scan imagery showing the decrease in function that happens to women as oestrogen declines, about 30 per cent of activity). Here is Dr Brinton again. “The women who were on hormone therapy had a highly significant 50 per cent reduction in their risk of developing Alzheimer’s, Parkinson’s multiple sclerosis and ALS. The longer a woman was on hormone therapy, the greater the reduction of risk.”

On the programme, Davina responds to this: “I can’t believe that! That’s completely fried my brain”.

Like many women in midlife, she has just struggled with watching her father die of Alzheimer’s. She spoke so movingly about how terrible that was.  She told me “I know that I am at higher risk than maybe other people. So this research is life-changing for me. It gives me hope.”

She is right, not just for those like her who have a higher risk, but for all of us. The cost of care for women in the UK with dementia is £23 billion. If even 10 per cent of women avoided Alzheimer’s by being given HRT early that could save over £2 billion, not to mention the hidden cost of suffering to families.

I don’t know about you but my biggest fear is losing my memory, my mind, everything that makes me, me. The idea that taking HRT and taking it early could reduce the chances of that happening would massively influence my decision making around whether to take HRT.

As a woman who has grown up with scare stories around HRT – I saw my mother and aunt worry about whether or not to take it, even while they were hot-flushing and suffering – because of those scare studies linking it to breast cancer. The knowledge now that actually HRT has health benefits, particularly for my beloved brain, is a game-changer. Women need to know about this. We shouldn’t just stagger on, suffering, thinking we are doing the right thing. These American female scientists are saying that whether or not we take HRT is not just about getting rid of hot flushes, or lifting mood (important though that is), but that our entire brain chemistry and brain health for the future can be helped by taking HRT. This needs to be general knowledge and it needs more research.

This is the critical reveal of the new Davina programme, but there is also some great new polling on menopause and work. They show that 14 per cent of women said they had reduced their hours at work because of menopause symptoms, while 52 per cent said symptoms such as brain fog and hot flushes had reduced their confidence at work and 1 in 10 women had left their job because of such symptoms. There was moving testimony from a teacher who had been fired because she was so tired; but who then started HRT and felt fine again. She just wished she had tried it earlier. A staggering  79 per cent of women of menopausal age had NOT tried HRT. Surely in the light of these findings in relation to the brain that has to change? It’s certainly changed my own thinking…

I was very moved by Davina’s stories of the huge impact of the first documentary last year. She says she can’t go anywhere now without being stopped by women telling their menopause stories and thanking her for breaking the stupid taboo around this issue. Dr Nighat Arif, our Noon menopause expert concurs: she has seen a massive upswing in women asking for HRT and inquiring about their menopausal symptoms since that first Channel 4 programme, as have MPs. One pharmaceutical company reported a 30 per cent uptick in demand. The Queenagers are definitely on the march. But way more needs to be done.

Last week the media was full of tales of countrywide shortages of HRT; the new documentary also shows Britain is a postcode lottery when it comes to who can get bio-identical hormones. In Scotland for instance the Yam based variety of oestrogen recommended by top menopause experts including Dr Louise Newson is unavailable; GPs cannot prescribe it. Also not available for far too many women is testosterone. Oestrogen, progesterone and testosterone are all crucial in our hormonal make-up – so why do we only replace two at menopause? Many women in the documentary spoke movingly about how taking testosterone had given them back their libido, va-va voom and clarity of brain focus. Yet NHS GPs don’t talk about it and cannot prescribe it. Indeed there is no mandatory training for GPs on menopause and the NHS website hardly mentions peri-menopause or testosterone. That has to change. If you want information you can trust, I recommend checking out The Menopause Charity set up by Dr Louise Newson, a campaigner and friend of Kate Muir (author of Everything You Need to Know about the Menopause (but were too afraid to ask)).

The doctors in the post-screening chat all said that a key game-changer in terms of government policy on menopause would be to make menopause treatment, whether or not a woman needs HRT, and other help to become a QAF. These are services – such as being called for a mammogram, or a cervical smear – that GPs get money for getting patients to turn up for. Every single woman (and some trans people, of course) goes through this change – so why is the NHS care available so unjoined up and patchy?

The women hitting menopause now are a pioneering generation. For the first time (according to the 2019 census) women over 40 are earning more money than women under 40 – because we have stuck with our careers, going back into the workforce after having kids unlike women before us whose earnings peaked at around 30.  Additionally, nearly a third of university-educated women aged 45-60 don’t have children – so for these professional women there has been no ‘motherhood penalty’. The point about this is that we are a generation with clout, financial and otherwise. We are not prepared to have the kind of menopause or midlife that older generations of women put up with. We are used to having a voice and we are not going to stop now. My more vociferous generation are the ones powering this new menopause conversation. We are not ashamed and we want information. But to get that we need to take action ourselves. Every midlife woman in the UK should think about to her MP demanding menopause screenings become a QAF and that GPs get better information and training and all women have access to decent treatment.

This isn’t just about HRT of course. Other things also help when it comes to keeping our minds and bodies healthy during menopause including taking more exercise, eating a Mediterranean diet, not smoking and not drinking too much. But we Queenagers are entitled to the information and access to treatment needed to supplement a healthy lifestyle – so we can overcome the menopausal symptoms and get on with living our best lives. Our Noon research shows that women at this point do not want to be branded menopausal, or seen as walking hot flushes – but they do want to get the treatment they need and deserve and not be seen as poor relations when we are 53 per cent of the population.

Sorry, this has been a bit of a rant. But the unfairness in health provision and outcomes for women – particularly older ones – makes my blood boil. We need to do something about this! And if we don’t agitate for it then nobody will. One good place to start is by signing this petition – and I really urge you to watch the new Davina documentary.

We also have some menopause resources for you to check out over on Noon. And while you’re there, please read this incredibly moving article by Kate Muir the producer of the Davina documentary (and an old pal of mine from The Times) about her mother, Alzheimer’s and how the research into menopause and the mind (which underlies this game-changing programme) came out of her own family situation.

Kate is an old friend and fellow traveller of mine. We worked together at the Times where she was the Film Critic and a columnist and I was Saturday Editor. When I first left that job and was miserable Kate had me over for tea and convinced me there was life after the mainstream media. I am so proud of everything she has achieved since. A great Noon icon. Her original piece when I launched the site about her menopause car crash is also well worth a read!

All the best,