Lancet study warns about “overmedicalisation” of menopause

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 women globally are viewed and treated, according to research published in The Lancet journal.

The Lancet 2024 Series, consisting of four research papers, highlights how some groups, such as those who experience early or cancer treatment-induced menopause often do not receive optimal care.

The Series questions the assumption that menopause often causes mental health problems and identifies specific at-risk groups who may need additional support.

The authors argue that a change in the narrative to view menopause as part of healthy ageing would reduce stigma and overmedicalisation, empowering women to navigate this life stage, acknowledged and supported by clinicians, researchers, workplaces, and wider society.

A new approach to menopause that better prepares and supports women during midlife is needed going beyond medical treatments, to empower women using high-quality information on symptoms and treatments, empathic clinical care and workplace adjustments as required, thy said.

“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,” said the Series co-author, Professor Martha Hickey from the University of Melbourne and Royal Women’s Hospital in Australia.

“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 amongst those who have yet to experience it,” Hickey said.

The Series calls for an individualised approach where women are empowered with accurate, consistent and impartial information to make informed decisions which are right for them over the menopause transition.

This may include taking menopause hormone replacement therapy (HRT) for symptoms such as hot flushes and night sweats, which can range from mild to extremely debilitating, after a discussion with their doctor about the risks and benefits, the researchers said.

“Whilst some women may also choose psychological therapies such as cognitive behavioural therapy to reduce the psychological impact of hot flushes and night sweats and improve sleep, Hickey said.

Welcoming the increase in awareness of menopause, the authors raised concern about the media’s tendency to focus on extreme negative experiences of menopause, depicting it as an unfortunate and distressing experience heralding a critical downturn in women’s health which can only be solved by hormone replacement.

“Whilst it is certainly the case that some women have extremely negative experiences of menopause and benefit from hormone therapies, that isn’t the whole picture,” said Lydia Brown from the University of Melbourne.

“The reality is much more complex and varied, with some women reporting neutral experiences and others highlighting good aspects, such as freedom from menstruation and menstrual pain,” Brown added.