Health
Helping women prepare for menopause
Over half the world's population will go through menopause and most of them will experience symptoms such as prolonged or heavy bleeding around menopause and hot flashes during peri-menopause, post-menopause or both. Frequent and severe symptoms can affect mood, sleep and ability to work. Despite this, there are significant gaps in the information and support available for women and those going through menopause. A recent UK survey found that 60% of women over 40 feel they are not well informed about menopause and almost a third are “afraid of it”.1 However, menopause was only introduced into the UK high school curriculum in 2020, meaning that many more generations of women are likely to enter menopause ill-informed and ill-prepared. A concerted effort is needed to address this gap so that women can get through menopause confidently and prepared.
Media portrayals of menopause are largely negative, and with so many commercial online sites it can be difficult to extract accurate and balanced information, with many “sources” exploiting women's uncertainty and fears for profit.23 For example, home testing kits claim to be able to diagnose menopause, but the fine print says that it still requires a medical evaluation. There are no reliable tests that can predict menopause in women over 45, and premenopausal syndrome is a clinical diagnosis.FourFive
These online commercial sites and products thrive because women struggle to get clear and consistent information from trusted sources, such as their health care providers.12 Menopausal symptoms are primarily managed in primary care, but are not a major component of GP professional training, leaving many GPs feeling underprepared and ill-informed.6 One survey of 173 GPs found that more than a third did not feel comfortable discussing how to manage menopausal symptoms, and only a quarter felt comfortable following clinical guidelines on menopause.6
Combined with educational disparities among GPs and severe limitations on consultation times, primary care interactions can result in the complexities of midlife being reduced to a checklist of symptoms and treatment options, while women's more holistic needs are ignored.7 Unfortunately, this leaves little time for a comprehensive discussion of lifestyle changes, mental health and non-pharmacological treatments such as cognitive behavioral therapy (CBT). Women, particularly in underserved areas, may be unaware of the support and treatment options available to them. Women in more disadvantaged areas are less likely to be prescribed hormone replacement therapy (HRT) than more affluent women, suggesting inequalities in access to healthcare during the menopausal transition.8 There are also gaps in knowledge about the menopausal experiences of women of different races and ethnicities, which impacts what information is needed and how it should be provided.9Ten
Making Menopause a Priority
How can we counter the negative media portrayal of menopause that leaves women feeling anxious rather than empowered, and counter predatory advertising of unfounded products? Women who are prepared are more likely to navigate menopause with confidence.11 Providing women with appropriate information and resources so they feel prepared is therefore a public health priority that should be addressed at the national level.
Health education programs have been shown to improve women's knowledge about menopause and encourage positive attitudes by providing them with tools to manage menopausal symptoms and increase their engagement in healthy habits.12 A coordinated public health approach can make evidence-based information about menopause more accessible in schools, workplaces and primary care. Online learning modules, workplace health sessions and discussions about menopause during appropriate routine health checks can ensure women receive consistent messaging and support throughout their lifespan.13 Actively reaching out to women, particularly those from underserved groups, can inform them about the support and treatments available to manage problematic symptoms, while also providing an opportunity to discuss evidence-based lifestyle changes such as weight optimisation, exercise and healthy eating.
Public education programmes should include accurate and realistic information about expected symptoms, self-care, where to get further support, and effective management options, from systemic and local HRT to lifestyle changes and CBT. The diversity of experiences should be recognised: for example, 60-80% of women experience some vasomotor symptoms, and in around a third of cases symptoms are moderate or severe.14 Enhanced primary care education could provide more information about which symptoms are attributable to menopause (and which are not) and the range of treatments available. Around 12% of women experience premature or early menopause, and diagnosis is often delayed.15 General practitioners should be aware of these women who may require intervention to optimise their long-term health.1516
Training in comprehensive menopause care should be integrated into medical school curricula and be an integral part of specialist training for general practitioners. Education should go beyond the risks and benefits of HRT to consider women's experience of menopausal symptoms in midlife and provide personalised advice, support and management options.
Stigma, shame and lack of education around menopause contribute to a lack of support for women and can undermine young women's confidence as they navigate this stage of life.17 As clinicians and researchers, we have a responsibility and opportunity to make meaningful changes in menopause care and improve women's expectations and experiences of this life transition. By providing the public with more evidence-based information and changing the narrative around menopause and ageing, we can better support and empower the next generation of women as they experience menopause.
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Author's Note: The authors acknowledge that not all women were assigned female at birth, and that some (trans)men and non-binary people may also experience menopause. We continue to explore the best ways to communicate our message in inclusive and accurate language, and appreciate your feedback.
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Provenance and peer review: Not commissioned or peer reviewed.
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Competing interests: MH declares salary funding from the Australian National Health and Medical Research Council, conference attendance support from the UK National Institute for Health and Care Excellence and the following roles: principal investigator of a clinical trial comparing salpingectomy with salpingo-oophorectomy for ovarian cancer prevention (TUBA-WISP II), board member of Breastscreen Victoria, editor of the Cochrane Collaboration, recipient of a fellowship from the Lundbeck Foundation (2022-23), site investigator of a clinical trial of a non-hormonal agent (Q-122) for vasomotor symptoms in breast cancer patients (QUE Oncology, 2020-22), and site investigator of a clinical trial of a medical device to treat vaginal dryness (Madorra). YP is salariedly employed by the Wales Gender Service, University of Bristol (through a National Institute for Health and Care Excellence 'Practice' fellowship – NIHR302823), Bristol Menopause Clinic and works part-time as a GP in Bristol. YP is a member of the British Menopause Society and the Society of Academic Primary Care but does not hold an advisory role with either organisation. JB receives salary funding as an NHS general practitioner and clinician at the Bristol Menopause Clinic. Research funding is provided by a Primary Care Clinician Career Progress Fellowship from the National Institute for Health and Care Excellence's School of Primary Care Research.
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Sources 2/ https://www.bmj.com/content/386/bmj.q1512 The mention sources can contact us to remove/changing this article |
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