Menopause Hormone Therapy and merchandise: why evidence matters

World Menopause Day was established by the International Menopause Society and the World Health Organisation in 2009, and happens every year on 18^th October. Its aim is to raise awareness of the menopause and the options available for improving women’s health and wellbeing throughout this time. Each year it has a new theme and this year’s is Menopause Hormone Therapy (MHT).

MHT has been the cause of much debate, concern and consternation for women and health practitioners. Perceptions of MHT have been influenced by the Women’s Health Initiative trial and the Million Women Study, both of which are credited with a previous decline in uptake. But prescription rates have increased again in line with the introduction of the MHT prescription prepayment certificate in 2023, more evidence in its favour and possibly because of the work of ‘influencers’ on social media. For example, in recent years, celebrities like Davina McCall have spoken publicly about their experiences of menopause and how they have benefitted from MHT.

In addition to promoting the benefits of MHT and sharing personal experiences of menopause, public figures have also influenced menopause care by endorsing commercial products (such as supplements, teas, shampoos, clothing and wearables) that claim to improve symptoms of menopause. The proliferation of these products has been termed the ‘menopause gold rush’ and they likely have gained traction not only due to celebrity endorsement, but also because of uncertainty about MHT.

The evidence behind these commercial products was the subject of recent research I undertook with Jamie Hartmann-Boyce that was featured on BBC’s Panorama: The Menopause Industry Uncovered.

The research aimed to find what types of commercial products are available on the high street and online, and to assess the evidence cited in their favour. We catalogued a wide range of information about each product, including what claims were made about them and if they cited any evidence in support of these claims. A focus group discussion resulted in 15 products being selected for further review, which involved assessing the cited evidence to determine if it supported the claims and if it was of good quality.

Claims for eight products were accompanied by evidence, but of these only one product had actually been subjected to appropriate testing. The evidence cited for the others was typically about individual ingredients, was based on cross-sectional data or similar so couldn’t make claims about causation, and, by and large, was of poor quality. No evidence was cited for the remaining seven products.

These findings raise several questions. What gap do these products fill and why are women taking them? What other aspects of menopause care are being touted to women without being supported by evidence? The answer to the former is that we don’t know, but we’re planning to find out. The answer to the latter is probably many, given the existence of what Sara Moger, CEO of the British Menopause Society, describes as ‘an enormous amount of misinformation and anecdotal information bombarding women…causing confusion, anxiety, apprehension and fear.’

So, what can be done to manage and mitigate misinformation about menopause? How can we ensure women are getting helpful facts and not the sales pitch from companies peddling their wares?

1. As a first step, we need more research and more research funding directed at menopause. Unanswered questions about menopause leave gaps that can readily be filled by anecdotal information and misinformation.
2. Secondly, we need to curb the commercialisation of menopause. Our research has shown that companies often misuse evidence to support the spurious claims they make about their products. Proper testing of these products should be mandatory.
3. Next, we need to ensure that no woman is left behind. We know that there are health inequalities when it comes to menopause care for women from lower socioeconomic status and racially minoritised backgrounds. We are addressing aspects of this in another project, but it is important that menopause research is designed to be inclusive of women who are often excluded.
4. Finally, we need to better support GPs to deliver care to women during all stages of the menopause in this time of misinformation.

What women need and what women deserve is robust, evidence based, objective and accessible information. Maybe World Menopause Day will soon be a celebration of how much better informed women feel about menopause. (One can but hope.)

Dr Anne-Marie Boylan is a Departmental Lecturer and Senior Researcher in the Centre for Evidence Based Medicine. She is the Director of the Postgraduate Certificate in Qualitative Health Research Methods and Co-Director of the DPhil in Evidence Based Health Care.