Menopause used to be a taboo topic in many quarters. Now, it’s .
Authors
Naomi Cahn
Professor of Law, University of Virginia
Bridget J. Crawford
Professor of Law, Pace University
Emily Gold Waldman
Professor of Law and Associate Dean for Faculty Development, Pace University
In March 2024, the announced an initiative to “Galvanize New Research on Women’s Midlife Health.”
In May, bipartisan legislation that would spend US$275 million to improve menopause care and midlife health.
The actor to help draw attention to the measure. While she was there, she shouted: “I’m in menopause.”
This and the greater openness to talking about it is occurring at the are underscoring the benefits of hormone therapy to treat menopausal symptoms – two decades after it suddenly fell out of favor.
The three of us believe open discussions about menopause are long overdue. We , , and . Having teamed up to write a book about , we are closely following the changes in how researchers assess the benefits of hormonal treatment and what that means for its availability.
Menopause basics
Technically, . It typically starts 12 months after the last menstrual cycle and marks the end of fertility, and it usually occurs between ages 45 and 55. It’s , a transitional phase during which menstruation changes but continues, that can last as long as a decade.
People who have gone through menopause are in postmenopause for the rest of their lives.
Menopause results from the body decreasing production of estrogen and progesterone, two hormones made by the ovaries. In the long term, bone density, the cardiovascular system and other parts of the body.
Menopause can also occur early and abruptly, such as after the .
Each year, more than . Millions more are at any given time.
While the , there is , ethnic and income lines. As life spans get longer, half the population may spend .
In particular, Black women tend to than white women. Their , are more acute, and . But Black women are less likely than white women to receive medical care for these symptoms.
What about perimenopause?
, which typically begins after age 40, the body gradually stops making estrogen – often bringing on menopausal symptoms. It can be whether someone is experiencing perimenopause, as estrogen levels fluctuate and there is no definitive test to determine it.
are .
Other symptoms include , depression, brain fog and vaginal dryness. Periods become irregular, and bleeding may be heavier. Not everyone going through menopause experiences symptoms – – and their severity varies.
Hormonal treatment and controversy
Menopausal , including estrogen alone and estrogen combined with progesterone, has been prescribed to help with those symptoms for decades. Hormones were also used to treat the associated with menopause, including heart disease and osteoporosis.
By the year 2000, approximately . Then, in 2002, the preliminary results of one study shook the medical world.
They were from the , a placebo-controlled study of menopausal hormone therapy that recruited thousands of women to analyze this treatment. Launched by the U.S. government’s ³Ô¹ÏÍøÕ¾ Institutes of Health in 1991, it remains the largest women’s health prevention study ever conducted.
In 2002, an interim analysis found that menopausal hormone therapy was associated with an increased risk of . The research was halted because of these results.
Within a few months, the use of hormone therapy to treat menopause symptoms . The share of all women using these prescription drugs and has been despite the growing recognition of the .
A has emerged in recent years, along with a careful review of the conclusions that led to the early termination of significant parts of .
One concern is that the typical age of the , meaning they were many years .
Another was that the study focused on the role of hormones in the , rather than the alleviation of menopausal symptoms. A third was that it of hormonal treatment.
Treatment today
Fittingly, many doctors are prescribing hormonal therapy for menopausal symptoms more frequently today – particularly for when they begin to take it and had their last periods within the prior decade.
Hormonal therapy can be dispensed through .
Tablets offer the convenience of oral administration, while skin patches provide a steady release of hormones through the skin. Gels allow for easy application and absorption through the skin, offering flexibility in dosing. Vaginal suppositories target local symptoms such as dryness and discomfort more directly.
It is also available with progesterone, although it’s .
However, there are for whom hormonal treatment is riskier than for others and should be avoided, including those with a history of breast cancer, other estrogen-sensitive cancers and coronary heart disease, among other conditions.
New, nonhormonal treatments for hot flashes are in development, too.
In 2023, the . It’s the and night sweats.
A may be marketed soon.
and other nonhormonal drugs are also being prescribed off-label to treat some menopausal symptoms.
Moving forward
Unfortunately, many patients and even aren’t fully aware of the latest evidence about .
Rates of menopausal hormone therapy use varies by race and ethnicity: White women have the highest rates, while . Without insurance, a month’s supply of . With insurance, costs may be much lower.
What all of the research shows is that symptoms should not be ignored, and individualized treatment is key. Given the new openness to discuss and deal with menopause, as well as potential research funding and new treatments, we’re becoming more optimistic that this inevitable life stage may finally get the attention it deserves.
The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.
