A new Series of four papers from The Lancet on menopause has argued that an over-simplified narrative of menopause as a health problem to be solved by replacing hormones is not based on evidence and deflects attention from the need for substantial societal shifts in how menopause, and midlife/older women in general, are viewed and treated around the world.

The Series, which has been contributed to by Professor Myra Hunter - Emeritus Professor of Clinical Health Psychology at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King's College London - seeks to highlight how some groups, such as those who experience early menopause or cancer treatment-induced menopause often do not receive optimal care.

Series co-author, Professor Martha Hickey, University of Melbourne and Royal Women’s Hospital (Melbourne), says “The misconception of menopause as always being a medical issue which consistently heralds a decline in physical and mental health should be challenged across the whole of society. Many women live rewarding lives during and after menopause, contributing to work, family life and the wider society. Changing the narrative to view menopause as part of healthy ageing may better empower women to navigate this life stage and reduce fear and trepidation among those who have yet to experience it.”

The Series considered four topics:

1. An empowerment model for managing menopause
2. Optimising health after early menopause
3. Promoting good mental health over the menopause transition
4. Managing menopause after cancer

Professor Myra Hunter, who contributed to the study from King's IoPPN said, “As well as menopausal hormone therapy, clinicians should discuss additional ways to manage some menopausal symptoms, such as cognitive behaviour therapy for hot flushes and night sweats. CBT may also reduce stress and improve sleep and mood. Lifestyle changes addressing diet, smoking and exercise may additionally benefit sleep and mood and improve long-term health. Some don’t wish to take menopause hormone treatment unless their symptoms are severe and prefer to use other approaches. Our Series is all about increasing awareness of evidence-based options for women, so they can choose how they wish to navigate menopause, free from judgement and stigma.” 

Unfortunately, commercial interests, such as organisations who are marketing menopause products to consumers including pharmaceutical companies and private providers, have strongly influenced media messaging about menopause and MHT. In this messaging, across both news media and social media, the small but serious risks of MHT are often downplayed or ignored.

This Series argues that women should have access to accurate and evidence-based information about menopause in a form they can understand, created without undue commercial influence, such as the NIH funded My MenoPlan website in the USA. 

The authors also call for more research into aspects of menopause that are a priority for women. For example, a global Menopause Priority Setting Partnership is underway across more than 40 countries to develop a new, patient-focused research agenda. 

Workplaces, by the creation of open, inclusive and supportive cultures, have a role to play in
supporting women during menopause. According to the UK Health and Safety Executive, women aged 45-54 report more work-related stress than men or women of any other age group, associated with high job demands, lack of control and lack of support.

A qualitative study of 137 women reported that women want their managers to be informed and empathetic about menopause and understand how the work environment might exacerbate their symptoms. 

The authors highlight how, through resources such Menopause at Work, employers can implement evidence-based and practical policies to support their employees including via education, conversations and flexible working hours. 

In addition to clinicians, researchers and workplaces, the authors highlight the need for a substantial societal shift in the views of midlife and older women, with a greater appreciation of their considerable contribution to society, their skills in the paid and unpaid workforce and how they often care for families across generations

"There is a lot we can learn about attitudes to menopause and growing older in general from
communities, such as many Asian cultures, where ageing in women confers respect and status, rather than stigma. Everyone can play a part in shifting society’s view of older women by engaging in conversation - such as those organised by the Menopause Cafe where people of all genders and ages gather to discuss menopause and share tips, questions and experiences,” says Rachel Weiss (not an author), founder of Menopause Cafe charity. 

She continues, “The pendulum has swung from 'put up and shut up' about menopause to
sensationalising it. It's good that we are talking more about menopause, now we need to swing the pendulum to the middle and normalise menopause, so that anyone who wants to talk about it can, so that people are not scared of it and so that a diverse experience of menopause is depicted in the media, not just celebrity horror stories.”

Globally, around 10% of women experience menopause prematurely (under age 40) or early
(between the ages of 40 and 44). There are often delays in diagnosis and some women experience feelings of distress and isolation. There is also evidence to suggest women who enter premature or early menopause may have an increased risk of conditions such as cardiovascular disease, and osteoporosis (fragile bones).

People with cancer are more likely to experience early menopause or menopause symptoms due to treatment. For example, endocrine therapy for breast cancer can cause hot flushes and/or night sweats that may be more severe and prolonged than natural menopause. Women with cancer often report a lack of centralised care and access to safe and effective treatments for their menopause symptoms.

Menopause does not usually cause mental health problems, but those with severe hot flushes/night sweats, previous clinical depression or recent stressful life events are at an increased risk of depression. There should be greater awareness and support for this group.

Whilst MHT helps with hot flushes and night sweats, it is not a treatment for depression and clinicians should offer evidence-based treatments depending on severity and patient preference.

Greater awareness, better understanding of mechanisms, new treatments and additional support for people who experience early menopause, menopause after cancer treatment and/or who are at a higher risk of depression over the menopause transition, is urgently needed.

The Series concludes all women should have access to realistic and balanced information about menopause and possible experiences, effective treatment as needed and shared decision-making to better equip them to navigate this life stage.

The full Series, Menopause 2024, can be found here.

 

For more information, please contact Patrick O'Brien (Media Manager)