A large number of doctors do not understand menopause. Health


A new analysis of a controversial study confirms what menopause experts have long argued: For many women, the benefits of short-term hormone replacement therapy outweigh their risks. This news comes at a time when the moment of menopause is approaching. (Also read | Irregular periods are not just menopause but can also be a sign of cervical cancer. Symptoms to watch out for,

Researchers found that for decades, hormone therapy may provide meaningful benefits while posing few risks for women in the early stages of menopause. (freepik)

Celebrities from Halle Berry to Gwyneth Paltrow are opening up about their journeys, while businesses, the medical establishment and the government are waking up to the needs of the 75 million women in America experiencing perimenopause, menopause or postmenopausal.

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But this is a moment that should be supported not by conjecture, but by solid data. A recent AARP survey estimates that menopause costs the US approximately $1.8 billion in worker productivity loss and $24 billion in related health care costs.

To be clear, hormones are not a panacea, nor are they the right choice for every woman. But the messaging about the use of estrogen and progestin has been so entrenched for so long that this treatment has become a symbol of the overall state of health care for women who are past their reproductive years.

Women entering middle age aren't being given straightforward, accurate information from their doctors — often, they're told nothing, or worse, given the wrong message.

All the confusion started in 2002, when the world of women's health was rocked by the sudden closure of a large study called the Women's Health Initiative. Designed to understand whether hormones could reduce a woman's risk of certain diseases, researchers found that the treatment increased the risk of heart disease, stroke and breast cancer. The message was that women should stop taking hormones and others should not start.

It changed the way care was delivered, depriving a generation of women of the therapy that's known to treat common symptoms of menopause, such as hot flashes, night sweats, vaginal dryness and bone loss.

The new data, shared last week in the Journal of the American Medical Association, comes from following women enrolled in the study for 20 years. Researchers found that for decades, hormone therapy may provide meaningful benefits while posing few risks for women in the early stages of menopause. It is also safe to use for most women in their 60s and 70s who are experiencing more serious symptoms such as hot flashes and night sweats.

Importantly, HRT did not increase the risk of heart attack. Nor did short-term use of both estrogen and progestin increase the risk of breast cancer. Additionally, since the Women's Health Initiative was halted, a range of new products have emerged offering different delivery methods – often at much lower doses – that may further reduce their health risks, although the authors Said that more study is needed.

To menopause experts, this update feels like old news. But it is still a big deal to have it stated in clear language in a medical journal.

Not all doctors have been able to keep up with the times. Lisa Larkin, president of The Menopause Society, says she regularly hears from women whose physicians refuse to prescribe HRT, with one just last week telling her that her doctor had advised her to follow “hormone-free practice.” Had claimed.

This divisive divide was underlined in a series of editorials published in The Lancet in March, which argued that menopause is a natural process that has become over-medicalized. The editors focused their criticism on HRT, suggesting that companies are adopting “feminist narratives” to push hormone therapy without acknowledging the risks.

Of course, we must be wary of movements that seek to turn a normal life process into a disease or sell us something to fix their invented problem. But the authors perpetuate myths about the universal dangers of HRT – which have now been firmly debunked. And just because symptoms are “natural” doesn't mean they aren't uncomfortable or disruptive — or not worthy of treatment.

Instead of being treated more, most women are “left to live out their perimenopausal and menopausal years without any medical guidance,” a group of menopause experts at Stanford University told The Lancet in their response.

Doctors in America are not educated enough to give good advice to women. A survey of American medical trainees found that only 7% said they felt adequately trained to help women through menopause. Another survey of OB-GYN trainees found that less than one-third were exposed to menopause curriculum during their residency. Yes, you read that right: Even some gynecologists don't provide guidance to women going through perimenopause and menopause.

This blank space is left for women to fill themselves. They may find solace in the growing number of experts on social media to provide accurate information about menopause. Or they can consult a host of new books (from The Menopause Manifesto to The New Menopause) that empower women by giving them solid information and the right questions to ask.

Still, I'm concerned about how much work we're putting on patients. Menopause is a transition that affects half the population; Women should not trust social media, which may contain as many impostors as true experts, nor should they investigate medical studies on their own.

Some incremental efforts may help. President Joe Biden's recent executive order creates a fund to close the knowledge gap about women's health, including money to improve our understanding of and care for menopause. And Congress should pass a bill introduced by a bipartisan group of senators last week that aims to support training, research and awareness around menopause with $275 million over five years.

it's a start. The changes that half the population will experience should not be so difficult to have a thoughtful conversation with a knowledgeable physician.

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