Many companies have a commercial interest in portraying menopause as a “medical problem”, leaving women inundated with misinformation and pushed towards ineffective treatments, a series of papers published in international medical journal the Lancet has found.
The findings have prompted leading doctors and researchers – including those from the US, UK and Australia – to jointly call for a societal shift that challenges inaccurate assumptions.
A review of the medical literature on menopause, which was part of the series, found misguided or harmful attitudes towards menopause were often pervasive in high-income countries.
These countries needed to learn from societies where ageing in women conferred respect and in which views of menopause were more affirming, the paper said, noting Indigenous communities in Australia considered menopause as less of a problem.
Rather than assuming midlife depression was often caused by menopause, societies should “promote gender equity and safety across the lifespan since early adversity increases the risk of poor mental health at midlife”, said the paper, which focused on mental health during perimenopause.
The lead author of the series and chair of obstetrics and gynaecology at the University of Melbourne, Prof Martha Hickey, and her co-authors raised concern about the media’s tendency to focus on extreme negative experiences of menopause, with menopause being depicted as an unfortunate and distressing experience, which could only be resolved with hormone replacement.
“A normal event that affects everyone has been turned into a disease – a hormone deficiency disease, which requires diagnosis and treatment,” Hickey said.
“And in a society that has very strong feelings about ageing and women, this is a disease which is thought to herald decline and decay amongst them.”
The paper argues that menopausal hormone therapy (MHT) should be available for those who need it, but the evidence showed it was only effective for hot flashes and night sweats, not other symptoms.
A small but serious risk of developing breast cancer remains, with the authors estimating one in every 50 women who takes MHT will develop breast cancer after five years of continued use.
The authors said impartial information was vital because often the messaging around menopause and hormone therapy had been strongly influenced by pharmaceutical companies marketing menopause products.
A separate paper published as part of the series offered the first clinical tool for diagnosis and management of early menopause, which affects the one in 10 women globally who develop menopause before the age of 40.
The framework guides clinicians to consider the nature and severity of symptoms, age and medical history, and the individual’s wishes to optimise their quality of life and health.
Meanwhile, Dr Lydia Brown from the University of Melbourne led a paper promoting good mental health during perimenopause.
She said the study did not seek to undermine the risk menopause could pose, but was about “emphasising individual differences in women’s experiences”.
“Some women may be at risk of depressive symptoms over the menopause transition, rather than all women,” she said.
Prof Susan Davis, who is director of the women’s health research program at Monash University, said guidance from international and national menopause societies, including Australia and New Zealand, “all speak to empowerment of every woman at this pivotal stage of her life”.
“They also stress the importance of an evidence-based approach,” she said.
“Nonetheless, in general, these papers align with, and support the latest internationally and nationally endorsed best practice guidance for menopause, published in 2023.”
Davis said it was also important not to minimise the important role of MHT in helping many women as they reached menopause.
Dr Sarah White, the CEO of Jean Hailes for Women’s Health, said the series was significant.
“We have the potential to have things go very, very wrong with how we consider menopause, because what we’re seeing is an incredible emergence of a for-profit industry associated with menopause,” White said.
“What started as a really terrific open discourse among women to break down some of the stigma around ageing and menopause is actually being co-opted by different industries.”
The series concludes that there is an urgent need for greater awareness, new treatments and additional support for people who experience early menopause, menopause after cancer treatment or who are at a higher risk of depression during perimenopause.
