Experts call for a new approach to menopause and support for women as they age

Martha Hickey, a professor at the University of Melbourne and Royal Women’s Hospital and series co-author, 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. 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.”

She continued, “The experience of menopause differs for every person. Our 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 therapy (aka 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. 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.”

Menopause as a part of healthy ageing

In many societies the topic of menopause has long been a taboo subject. Now, countries such as the UK, the USA and Australia are experiencing a ‘menopause moment’, with more open discussion across politics, workplaces and the media.

Whilst welcoming the increase in awareness of menopause, the series’ authors raise 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.

Lydia Brown, a senior lecturer at the University of Melbourne, said, “Whilst it’s certainly the case that some women have extremely negative experiences of menopause and benefit from hormone therapies, that isn’t the whole picture. 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. Menopause is having a cultural moment, and this is an opportunity for it to be recognised as a natural part of healthy ageing for women which, with the right preparation and support, is not something to fear.”

There is a widely held belief that menopause is associated with poor mental health, however a review of 12 studies, published as part of the series, which investigates the association between the menopause transition and depression does not confirm this. Two of the 12 studies report increased depressive symptoms over menopause, but three found no such increase, and the remaining seven studies report mixed results. After reviewing these studies and others, the series’ experts conclude there is no robust evidence that risk of anxiety, bipolar disorder, psychosis or suicide increases for all women over the menopause transition.

Empowered women with support across society

The series calls for healthcare professionals, researchers, workplaces, and wider society to support the empowerment of women during menopause, ensuring they have the knowledge and self-determination to make informed decisions and can seek effective help if needed.

Healthcare workers can support their patients by validating their experiences and providing balanced and consistent information about symptoms and treatment options if required, encouraging women to discuss their individual preferences to reach shared decisions.

A review of evidence on menopause symptoms highlights that hot flushes and/or night sweats affect up to 80 per cent of women, with over a third (38 per cent) describing these symptoms as moderate to severe at age 50 years.

The most effective treatment for hot flushes and night sweats is hormone therapy - often referred to as Menopausal Hormone Therapy (MHT) or Hormone Replacement Therapy (HRT). Treating hot flushes may also improve sleep and mood, and MHT prevents fractures in weak bones. However, evidence on the benefit of menopause hormone therapy on other symptoms associated with menopause and ageing in women is lacking.

Andrea La Croix, a professor at the University of California San Diego Herbert Wertheim School of Public Health and Human Longevity Science, commented, “There are several medications for menopause symptoms available as prescriptions that can be crucial tools in helping some women manage hot flushes and night sweats, possibly also leading to improved sleep and quality of life.