The recent pronounced increase in public discussion of the menopause has been a welcome shift. Like miscarriage and birth injuries, this aspect of women’s life experience – and healthcare – has often been shrouded in embarrassment. In the UK, a “menopause revolution” led by the Labour MP Carolyn Harris succeeded in getting the cost of hormone replacement therapy (HRT) reduced to less than £20 a year. Between 2021 and 2023 the proportion of UK women aged 45 to 64 prescribed HRT rose from 11% to about 15%.
This is widely viewed as a corrective after many years during which it was underprescribed due to exaggerated fears about side-effects, including an increased risk of some cancers. Women with debilitating symptoms such as broken sleep and low mood too often went without any treatment at all. Last month the Equality and Human Rights Commission (EHRC) issued new guidance asserting that if symptoms are serious and long-lasting, they can be regarded as a disability – meaning employers must make reasonable adjustments. Meanwhile, a new series of papers in the Lancet has called for more support for the one in 10 women who experience early menopause, before they are 40.
The goals of raising awareness, improving treatment and challenging the stigma associated with female ageing and loss of fertility are widely shared. But there are also differences in approach. At issue is the extent to which menopause is regarded as a condition to be treated, with the authors of one new paper arguing that this is a problem in high-income countries, including the UK and Australia. They propose that menopause should not be viewed as an endocrine deficiency, but as a “normal event that affects everyone”. Using similar language, the South African activist Sue Mbaya describes menopause as “a normal developmental stage”.
The Lancet authors believe women are being targeted by a growing menopause industry that is eager to capitalise on their anxieties, and cite evidence that for most women menopause symptoms are not severe. The recent UK campaign was guided by new research on dementia and Alzheimer’s, and heightened awareness of the importance of bone strength for older women – who have an elevated risk of developing osteoporosis. But the evidence about the long-term use of HRT is weak. Pharmaceuticals businesses, as well as unregulated online influencers, play a part in shaping public opinion in the UK as elsewhere.
New, non-hormonal treatments are being developed. Research also supports a role for talking therapies in helping women navigate what used to be called the “change of life”. But while women ought to benefit from a more diverse approach to treatment, a form of polarisation can be observed in some reactions to these developments – with pro- and anti-HRT voices on opposite sides.
Many people have strong feelings about negotiating the ageing process. Distrust about the way that menopause is dealt with, both socially and medically, is part of a wider critique of the way women and their bodies have historically been overlooked. But discussion of menopause must not be reduced to a question of yes or no: for or against HRT – particularly since there are many women whom it doesn’t suit (including those with a history of cancer). In an imperfect world, we must hold on to the ideal of each woman deciding, in consultation with her doctor, what is right for her.
