Why Are There So Many Menopause Knowledge Gaps?

On average, 1.3 million people assigned female at birth are expected to reach menopause every year in the United States. Many of these people will experience menopausal symptoms that seriously affect their quality of life, such as hot flashes, trouble sleeping, and mood changes.¹

You might expect a reasonable awareness in the medical and wider communities about menopause-related issues, but that’s not quite the case. This is particularly concerning given recent research has linked menopause to cardiovascular disease, Alzheimer’s disease, and osteoporosis.² ³ ⁴

So why is it still common for health professionals around the world to be unsure about menopause? Why do women continue to suffer and, in some cases, not have their symptoms taken seriously? We’ll look at some possible answers in this blog.

What is menopause?

Menopause is the point in your life when your ovaries no longer release eggs for fertilization. It’s typically referred to as a life stage.

You will have gone through menopause after your periods have disappeared for over a year without hormonal interference.⁵

With over 84% of women experiencing period pain, many look forward to the day their period stops forever. This happens around the age of 51 in most cases. Some studies have shown that women typically enter menopause around the same age as their mothers.⁶ ⁷ ⁸

Pregnancy cannot occur naturally after menopause, so you can stop using contraception. If you are still trying for a baby, options like in vitro fertilization (IVF) and surrogacy may be available.

If you use hormonal birth control, a year without periods won’t necessarily mean you have reached menopause. This is because hormonal birth control can alter your menstrual cycle. Your doctor can confirm whether you have reached menopause, so it’s best to speak to them about what you’re experiencing.

Around 1% of women reach menopause before the age of 40. This is known as premature menopause. Certain treatments, like chemotherapy or antiestrogen medication, can cause menopause to occur earlier than usual. It also depends on your hormones, genetics, and any medical conditions you have. It’s important to seek medical attention if you suspect premature menopause.⁹ ¹⁰ ¹¹

Different types of hysterectomies, ranging from partial to total, can also induce menopause. A doctor may offer a hysterectomy in certain cases to surgically manage conditions such as heavy menstrual bleeding, endometriosis, prolapsed uterus, or fibroids. In other cases, it may be necessary to treat uterine cancer.¹²

A radical hysterectomy procedure induces menopause, as does having both ovaries removed with a hysterectomy and oophorectomy. Even if you keep one or both ovaries, there may still be a risk of hormonal imbalances and even ovarian failure within five years of surgery. This may cause you to transition to perimenopause.¹³

What is perimenopause?

You may have heard of the term “perimenopause.” This is the stage before menopause. The word means “around menopause.”

Perimenopause generally lasts 4–8 years, with most people entering perimenopause in their mid-to-late 40s.¹⁴

The ovaries shrink and create less estrogen during perimenopause. Hot flashes are one of the most recognizable signs that you’ve reached perimenopause, but did you know there are over 30 menopause-related symptoms? They include:

Hot flashes/flushes (also called vasomotor symptoms)
Night sweats
Chills
Sleep problems
Irregular periods and other changes to your cycle
Mood changes
Bloating
Brain fog
Anxiety
Joint pain
Loss of libido
Vaginal dryness, causing painful intercourse (dyspareunia)
Slowed metabolism, causing weight gain
Decrease in size and firmness of breasts
Dry skin and thinning hair

Changes happen gradually and can be mild to severe. You may not notice symptoms at first. As many as 90% of women visit their doctor to ask for help managing their symptoms.¹⁵

Including all women in medical research

Understanding menopause and how to help the millions of people assigned female at birth who go through it every year is vital. People are living for longer, so they deal with the effects of menopause for many more years.

Despite this, there are still obvious gaps in menopause knowledge perpetuated by historical and current worldwide inequalities in medical research and care.

In 1977, the US Food and Drug Administration (FDA) released a guideline called the “General Considerations for the Clinical Evaluation of Drugs.” The guideline essentially prevented women of childbearing age from participating in studies unless they had a life-threatening condition. Even then, many women struggled to join clinical trials.¹⁶

Seemingly, the intention was to protect any potential fetuses from unexplored risk. In practice, this policy disregarded women’s agency over their own bodies and prevented them from participating in research into their own medical conditions.

The FDA didn’t revoke these guidelines until 1993, when the organization published an updated guideline. This new guideline acknowledged that there were ethical and legal issues with the recommendation that women of childbearing age couldn’t participate in clinical trials.¹⁷

The ongoing gender gap in medical research

Have things changed at all since that controversial guideline was revoked? In many areas of medicine, it seems not.

ResearchGate found there is more than five times as much research into erectile dysfunction (ED) than premenstrual syndrome (PMS). This is concerning given ED affects 19% of men during their lifetime, while PMS affects 90% of women.¹⁸

Cardiovascular health is another area of medicine affected by stark research disparities. A 2018 study found that women were underrepresented in clinical trials for coronary artery disease, acute coronary syndrome, and heart disease between 2005 and 2015.¹⁹ ²⁰

According to a report by the British Heart Foundation, the gender gap in cardiovascular research contributes to women being disadvantaged when it comes to awareness, diagnosis, and care. This ultimately leads to more women dying of coronary artery disease and heart attack.²¹

It appears there’s still a way to go in closing the gender gap in medical research. Until then, women will continue to be disadvantaged when seeking a diagnosis and care in areas of medicine ranging from cardiovascular health to menopause.

75% of women are left untreated when they seek help for menopause symptoms

Women around the world face discrimination and power imbalances, making it hard for them to speak up and get the right treatment. Gaps in healthcare also affect different subsets of women, including those with different sexualities, racial backgrounds, and gender identities.

In the US, analysts can obtain many insights from data about healthcare claims. The 2019 Global Burden of Disease Study revealed that only one in five women in the US with a health condition was diagnosed. The statistic for men was a little different: two in three men received a diagnosis for their medical condition.²²

A study conducted by a Danish research group published in early 2019 echoed these findings. Health data from 6.9 million patients uncovered that, on average, women were diagnosed with health conditions four years later than men.²³

A Yale University review of insurance claims found that while 60% of women with significant menopausal symptoms seek treatment, nearly 75% are left untreated.²⁴ ²⁵

“Nearly one-third of this country’s women are postmenopausal, and many of them are needlessly suffering,” says gynecologist Wen Shen, an assistant professor in the John Hopkins School of Medicine Department of Gynecology and Obstetrics.²⁶

If you do get a diagnosis, it might not be correct

Doctors sometimes overlook menopause symptoms because they can be similar to those caused by other conditions. The Menopause Charity notes six common misdiagnoses:²⁷

Cystitis
Thrush
Depression
Chronic fatigue syndrome (CFS)
Irritable bowel syndrome (IBS)
Fibromyalgia

Receiving an incorrect diagnosis can be incredibly frustrating when you’re just seeking relief, especially if your symptoms affect everything from your sleep to your professional life.

Fewer than 7% of doctors feel adequately prepared to treat menopausal women

If you’ve ever had a gynecological issue that you’ve sought treatment for, you’ll know it’s not uncommon to hear there’s no need to worry and that your symptoms are completely normal. You might even get the impression that your nurse or doctor thinks you’re exaggerating or being too dramatic.²⁸

In 2019, researchers sent an anonymized survey to trainee doctors to assess their preparedness for menopause management and their knowledge of this area of medicine. Fewer than 7% felt adequately prepared to treat people experiencing menopause, and the survey identified important knowledge gaps.²⁹

Perhaps that’s not surprising given 50% of family medicine doctors had only one lecture on menopause. 20% had no lectures at all. For such a complex topic, this is clearly insufficient. Every system in the body is affected as estrogen levels fall, and for women to receive proper treatment, doctors need to properly understand the effects and how to ease them.

Menopause is nothing new, so why is it still taboo?

Menopause is a phase of life that should be celebrated as a new opportunity to thrive. That involves ensuring women struggling with symptoms have access to the medical, social, and workplace support they need.

In reality, though, menopause is still a taboo — something to be hush-hush about. But why?

Western society’s views on female aging play a big role. Social attitudes are tinged with ageism and sexism.

Female aging is typically viewed negatively or simply not spoken about at all. In a study published in 2016 on gender and body image in women over 50, women voiced “a sense of injustice in their aging experience, recounting external pressures from society about appearance that were different for aging men.” Many women surveyed reported feeling “irrelevant and invisible” once they reached this life stage.³⁰

The menopause taboo means women may feel uncomfortable speaking up about their symptoms and seeking medical help to address them. Living with symptoms and not receiving appropriate medical care, particularly for mental health symptoms, can make this time extremely confusing and frustrating. It can also make navigating your personal and professional lives particularly challenging.

In 2019, British journalists asked people to get in touch with their personal experiences of menopause. Some reported having understanding doctors and access to treatment, but others said the experience was more challenging. Some participants said they felt frustrated about the contradictory advice they received. Others said they were “unprepared for the experience,” meaning they struggled to understand what their symptoms meant.³¹ ³²

Workplace difficulties due to menopause symptoms were widely reported. One woman told reporters that she had been signed off work. Another faced a lack of support and understanding from colleagues and eventually underwent disciplinary action.

A 2020 British Medical Association (BMA) report surveyed 2,000 doctors about how menopause affected them at work. 90% said their symptoms impacted their working lives. Many said they didn’t receive support from their employer, and others faced ageism and sexism if they mentioned their symptoms. Only 16% told their manager about what they were dealing with; many felt that bringing up a “taboo” subject wasn’t worth the hassle.

Some Asian and Scandinavian cultures celebrate menopause. Interestingly, research shows that people who experience menopause around these positive attitudes report fewer symptoms and generally have a more comfortable experience.³³

However, positivity around menopause doesn’t always translate to women being able to easily access healthcare. Unfortunately, wider stigmas surrounding female health in some cultures act as a barrier to women seeking the medical help they need.

The right treatment can improve your quality of life

Although you might struggle to have your symptoms recognized and taken seriously, proper treatment can improve your quality of life. Try to advocate for yourself confidently, and don’t be afraid to ask for a second (or third) opinion.

Your doctor should be able to talk you through the different types of treatment and explain the pros and cons of each. You might find that your symptoms change over time. In this case, setting up a regular half-yearly or yearly appointment is a great way to stay on top of your changing symptoms and needs.

So, what treatments can ease menopause symptoms?

Hormone replacement therapy (HRT)

HRT is also known as menopausal hormone therapy (MHT). Here are the hormones you can boost with HRT:

Estrogen: Most symptoms, including hot flashes and joint pain, are caused by low estrogen levels. You might find increasing estrogen levels improves your symptoms. You can also use vaginal estrogen to treat vaginal dryness and painful intercourse.
Progesterone: Progesterone (or the synthetic version, progestogen) is another key hormone. If you have an intact uterus and want to take estrogen HRT, your doctor will recommend taking progestogen simultaneously to reduce your risk of endometrial cancer. Your doctor may not prescribe progesterone if you have had a hysterectomy.
Testosterone: This hormone can improve symptoms of low sex drive, poor concentration, and low energy.

HRT comes in various forms. Vaginal estrogen comes as a cream, pessary, or tablet. Progesterone is also available as an intrauterine device (IUD). Your doctor should advise which treatment is best for you, and you can discuss which formulation you would prefer.

While HRT may sound like a miracle cure, it’s unsuitable for some. Women over 60 are more likely to experience a stroke while taking HRT, and it’s not recommended if you have a history of blood clots or have uncontrolled high blood pressure.³⁴

HRT and cancer

Conversations about HRT usually include a mention of the increased risk of cancer. It’s a little more complex than this. Your cancer risk depends on many things, including your genes, age, general health, and lifestyle. How long you have taken HRT and the age you started taking it also affect your risk.³⁵

A large study of half a million women discovered that fewer than one in 1,000 will develop breast, ovarian, or uterine cancer due to HRT. Unfortunately, breast cancer is a common condition affecting one in seven women. This means you risk developing the condition regardless of hormone therapy.³⁶ ³⁷

Some studies have shown that it’s safe to take HRT with a family history of these cancers, including those caused by the BRCA gene. Your doctor will confirm if the benefits outweigh the risks for you.³⁸

Tibolone

Tibolone is another form of HRT. It’s a progestogen, a synthetic version of progesterone.

Research has shown that tibolone reduces hot flushes and the risk of fractures while increasing sexual function.³⁹

Tibolone is only suitable for postmenopausal women, meaning 12 months have passed since your last period without any hormonal interference. The hormone will also be unsuitable for you if you cannot take HRT/MHT. Like HRT, it increases your risk of cancer, affecting the womb and ovaries.⁴⁰

Some antidepressants

Studies have shown that some types of antidepressants can reduce hot flashes. These include selective serotonin reuptake inhibitors (SSRIs) (paroxetine, citalopram, and escitalopram) and serotonin and norepinephrine reuptake inhibitors (SNRIs) (venlafaxine and desvenlafaxine). They can also ease mood swings and depression.⁴¹

These medications can cause unpleasant effects, such as a dry mouth, nausea, and constipation. These side effects often ease after the first week. Your doctor can advise you if this type of treatment is a good option for you.

Gabapentin

Gabapentin (Neurontin, Gralise, Horizant) is an antiseizure medication that may relieve hot flashes, night sweats, and insomnia in some women.

Side effects can include nausea and sedation, among others.

Birth control pills

Combined birth control pills regulate your estrogen levels. They can reduce some menopause symptoms, such as irregular periods and hot flashes. On the other hand, they mask symptoms like your menstrual cycle changing, so you may think you’ve reached menopause when you haven’t.⁴²

Over-the-counter vaginal creams

Vaginal dryness is a very common condition during menopause, yet it’s rarely spoken about because of embarrassment. Over 50% of women don’t report this symptom to their doctor.⁴³

Dryness doesn’t just affect your sex life — it can impact your everyday life if it’s severe. Some people experience constant pain and discomfort.

Using lubricants before sex or tampon application generally provides immediate help, and applying moisturizer daily can also ease symptoms. Ask a doctor or pharmacist whether they would recommend estrogen- or water-based treatments for your individual circumstances.

Lifestyle changes

Medication isn’t the only thing that can ease your symptoms. Lifestyle changes are crucial in any treatment plan.

You can take steps to implement these lifestyle changes to improve your menopause symptoms:

Increase physical activity — Short weight-based workouts, from walking to lifting weights, can be incredibly fruitful for your body and mood. Benefits include increased muscle tone and strength, speeding up your metabolism, increasing bone density, protecting yourself from brain degeneration, and boosting your mood.⁴⁴
Eat well — A healthy diet is always important, but it’s even more vital during menopause to protect your metabolism and bones. Low-calorie diets are not the best approach. Instead, consume a nutrient-rich diet that contains whole grains, fruits, and vegetables with the calorie content required for your body weight.
Get better sleep — Sleep can be tricky at any time in your life, let alone during menopause when your body is going through significant changes. Studies have shown that sleep is of lower quality during menopause due to night sweats and other hormonal changes. You can improve your sleep by practicing good sleep hygiene. This includes going to bed early and maintaining a regular sleep schedule.⁴⁵

The lowdown

Menopause can be a stressful transition that brings many uncomfortable symptoms as your body and hormone levels change. Despite medical advances and the fact that millions of people go through menopause each year, there are still inequalities and stigmas attached to the topic. These make seeking treatment and support quite challenging for some women.

Hopefully, with more research and awareness, things will change for the better. In the meantime, don’t be afraid to stand up for yourself and request a second opinion if you feel you’re being ignored.

Medications and lifestyle changes can ease some symptoms. It’s important to keep on top of your health at this time as your risk of heart disease and osteoporosis increases. Keeping active, consuming a healthy diet, and improving your sleep are great ways to take control of your health.

The information provided is designed to support, not replace, the relationship that exists between a patient/site visitor and their existing health care professional(s). Have feedback? Email content@healthmatch.io.

References:

Victoria is a writer from the UK with a keen interest in health and science. She loves writing about mental health, scientific advancements, and dispelling pseudoscience. When she’s not writing sass-laden articles, she walks her rescue dogs, giggles at anxiety memes, eats chocolate, and absorbs useless knowledge for quiz shows.

Have you considered clinical trials for your medical condition?

We make it easy for you to participate in a clinical trial for your medical condition, and get access to the latest treatments not yet widely available - and be a part of finding a cure.

Check your eligibility

Solutions

Resources

Clinical trials

Topics

Guides