Menopause Myths and Misinformation

Menopause and perimenopause are currently having a moment. Like anything that has popularity and revenue potential, these topics have prompted people with various levels of expertise to proclaim that they should be the resource for all things midlife and beyond. But, as with all other popular topics, the type and validity of the information available vary. How do you know what is true and what is false?

It seems one of the biggest controversies surrounds the use of menopausal hormone therapy (MHT). There are endless studies and opinion pieces, as well as exciting magazine spreads, talking about hormone therapy as if it is the solution to all the problems of midlife and menopausal women.

Unfortunately, hormone therapy has remained controversial for years, mostly due to the results of a decades-old study called the Women's Health Initiative (the WHI). This was one of the largest studies conducted on the health of postmenopausal women in the United States. When the findings were released in 2002, it was suggested that women in the study who were on hormone therapy had an increased risk of cardiovascular disease, stroke, dementia, and breast cancer. Immediately, millions of menopausal women discontinued their hormone therapy regimens, and almost all doctors stopped prescribing it.

It has since been revealed that the average age of women in the study was 63, which did not reflect the age at which women generally seek care and relief for menopausal symptoms. Most menopausal women seeking relief from symptoms are much younger, and many subsequent studies have not shown similar results to the WHI.

However, recent polls have shown that only 3% to 5% of women in the typical menopause age range who are eligible to take hormones are currently taking them. Current evidence shows that estrogen is an important hormone for most women, and the benefits of hormone therapy clearly outweigh the risks when it is used appropriately. Through the years, the pendulum has swung both ways, and beliefs that women and their doctors now have about hormone therapy are very different from what was believed five, ten, or twenty years ago.

Not all studies are created equal, and not all conclusions drawn from those studies prove that a particular treatment or medication works well and is safe. It's important to know what type of proof or evidence is being offered to help make good decisions about menopausal treatments and care. Information on menopause comes from sources as varied as social media influencers with no medical background to physicians and nurse practitioners certified by The Menopause Society to evaluate and treat women seeking menopausal care.

There are several myths and pieces of misinformation that have persisted as beliefs when talking about the safety of menopausal hormone treatment. New information and evidence have been revealed over the last 25 years, changing the entire field of menopausal medicine.

1. Many women believe that it is safer to treat menopausal symptoms with “natural” or “herbal” supplements or treatments

There is no good research showing that supplements like Chinese herbs, evening primrose oil, or wild yams reliably and safely reduce menopausal symptoms, and some, like black cohosh, can even cause other problems, such as liver toxicity. FDA-approved menopausal hormone therapy has many randomized controlled studies, the gold standard for research, supporting the safety and efficacy of these treatments.

2. It used to be thought that women should be on the lowest dose of hormones available and for the shortest amount of time possible

This is a myth. It is now believed that, as long as no medical problems develop that would cause you to no longer be a safe candidate for hormone therapy, you can stay on hormones as long as you want. If menopausal hormone therapy was initiated within the first 10 years of menopause, there is no time limit, especially if the hormones are helping to relieve menopausal symptoms like hot flashes or night sweats. Estrogen reduces the risk of developing a hip fracture due to osteoporosis by as much as 50%. The decision about how long to stay on hormones and what doses to use should be an individual one that you make with your medical provider.

3. It is believed that hormone patches are safer than pills

This belief applies to the method by which estrogen is delivered into your bloodstream. Pills, patches, creams, and gels are all generally safe, but methods that go through the skin, such as patches, creams, and gels, gradually release small amounts of hormone into your body and are less likely to increase the risk of blood clots forming. However, much of the data we have regarding estrogen's protective effects on bone and cardiovascular health is based on studies conducted with oral estrogen pills only. It is unknown whether that data completely applies to patches and whether they have the exact same effects.

4. If you are on systemic estrogen, you don't need vaginal estrogen

This is a myth. While it is true that using estrogen systemically, through oral pills, transdermal patches, or gels that you rub into your skin, can have enough of an effect on the vaginal and vulvar tissue to treat dryness there, many women also need topical estrogen. Topical vaginal estrogen, in a cream, insert, or ring, treats only local symptoms: vaginal dryness, painful sex, lack of lubrication, and bladder irritability. Using both methods is not somehow “too much” estrogen.

Where should you get your perimenopause and menopause information?

There are so many sources, but there are a few red flags to look out for when deciding whether the source you're reading is credible.

1. Are they trying to sell you something?

If a blogger, online poster, or influencer is posting some type of information and then encouraging you to purchase something from them related to this information, this is a conflict of interest. If a person earns money from selling a product or service, they have a strong incentive to present that information in a way that will push you toward the sale. This makes their advice or reviews less trustworthy.

A consultant can charge for information they provide because charging for expertise is part of a normal business relationship. The value is in the service, not in the product. Selling a product, even if the seller truly believes in it, still presents a conflict if the same seller is in a position to provide information that would influence the choice to buy.

2. Does the information, or the person providing it, state that they have “the solution to all of your problems”?

Science is more nuanced than having a one-size-fits-all solution, and most effective and safe menopause plans come from a combination of lifestyle interventions, good sleep habits, and possible use of hormones to relieve symptoms. Saying that a particular supplement, estrogen, or testosterone will do everything from solving weight gain issues to regrowing hair and preventing dementia is not grounded in science or evidence. It is even worse when they recommend expensive, unnecessary testing and then provide the purchasable solution to the abnormal test results.

3. Do they discuss their sources? And are those sources other than the company that makes the product they are trying to sell?

Look for primary evidence from academic studies and reputable organizations, such as The Menopause Society, the American College of Obstetricians and Gynecologists, and the International Society for the Study of Women's Sexual Health, to check scientific integrity. If a company that sells a supplement conducts all the studies showing that the supplement works, that company has a financial stake in the outcome. The bias will be toward reporting positive results, even if unintentionally.

Even if the data are collected properly, results can be reported to emphasize only the data that align with the desired outcome, a practice called “cherry-picking.”

The bottom line is that all women should become advocates for their own care. Look for the red flags, seek out trusted resources for information, and find a medical practitioner who “looks at the whole person.” Find someone who believes that diet, exercise, the right supplements, stress management, good sleep, mental health support, and a personalized perimenopause/menopause plan, (which may include MHT,) are all important parts of your treatment. It is certainly possible that hormone therapy will help relieve your symptoms today and support your health well into your future.