Most women going through menopause are not receiving effective treatment for their symptoms, in part because of widespread misinformation, according to new research.
A comprehensive literature review led by Prof Susan Davis from Monash University in Australia and published on Thursday calls for more personalised treatment plans that address the greatly varying physical and mental symptoms of menopause.
After adverse affects were reported from the landmark 2002 Women’s Health Initiative study into menopausal hormone therapy (MHT), Davis said there was a blanket fear that “hormones are dangerous” and as a result, “menopause [treatment] just went off the radar”.
“Now there’s been this real surge of interest in menopause,” Davis said. The journal Cell invited Davis and her colleagues to provide a comprehensive summary of what is known about menopause, what’s not known and the challenges in the area.
“One of the challenges being most symptomatic women are not getting appropriate therapy,” Davis said.
More than 85% of women in high-income countries do not receive effective, regulator-approved treatment for their menopausal symptoms, according to the review, which examined over 200 sources going back 71 years.
“Midlife for women can be pretty tough,” Davis said. “They’ve got a lot of balls in the air. They’re balancing a lot of things in their life. And then you add into the mix sleep deprivation from hot flushes and night sweats, unexplained waves of anxiety, lack of confidence [and] vaginal dryness so you don’t want to have sex with your partner because it hurts.
“A whole lot of these symptoms are treatable. But you’re not being treated, and that really impairs your quality of life.”
In some cases, Davis said, hormone therapy is inappropriately prescribed when other treatments such as lowering blood pressure and correcting cholesterol would be more appropriate.
However, many ineffective therapies are advised as a result of persisting misinformation around menopausal hormone therapy, which is a medication that contains oestrogen, progesterone and sometimes testosterone used to manage the symptoms of menopause.
“On the wave of the fear factor [around MHT] came all the people who said you can take all these alternative herbs and spices and things that are going to make you better with no foundation. But because women were symptomatic and fearful of hormone therapy, if you’ve got terrible symptoms, you will take what you can get.”
While the paper found evidence-based nonhormonal interventions are also available for symptom relief, “the most effective treatment for bothersome menopausal symptoms is evidence-based, menopausal hormone therapy (MHT), which reduces bone loss and may have cardiometabolic benefits”.
While only 30% of women going through menopause will have moderate to severe symptoms, Davis said there are often silent changes in the body, such as loss of bone density.
Davis encouraged all people experiencing menopause to have a full health check because “optimising health at menopause is the gateway to healthy ageing for women”.
Prof Rodney Baber from the University of Sydney said the review provided an up-to-date account of the most important issues in the field in a “fair, evidence-based way”.
“One of the issues for many women is they will almost all try over-the-counter complementary therapies before they engage with a doctor to discuss hormones,” Baber said.
“When menopausal hormone therapy is used to alleviate symptoms in postmenopausal or perimenopausal women the benefits of the treatment in terms of alleviation of symptoms, cardiometabolic health and bone health are significant and the risks are in fact very low.
“This review shows us that there [are] still some aspects of the physiological changes in the perimenopause and postmenopause that require more research to understand what goes on,” he said.
Baber said the review also showed that most data is from women living in western countries and more information about women living in other countries was needed.
The research was published in the journal Cell.
