NEW DELHI: Highlighting that menopause is not the period of “decay and decline” but a developmental life stage, The Lancet warned against the “over-medicalisation” of this natural phase of life.
The Lancet 2024 Series, consisting of four research papers, said that menopause is not a disease. It called for the need to reframe menopause and to look for a management approach that is not focused on medical interventions to relieve symptoms.
“For most women, menopause is a natural phase of life that they transition as part of biological ageing,” it said.
It argued that the “framing of this natural period of transition as a disease of oestrogen deficiency that can be eased only by replacing the missing hormones” fuels negative attitudes toward menopause and exacerbates stigma.
The series said commercial organisations position the use of menopausal hormonal therapy (MHT) as a way to empower women to regain control of their bodies while downplaying risks. It said this further endorses the framing of menopause as a disease.
It argued that menopause is commonly perceived to be associated with poor mental health. However, it said, there is no strong evidence that the risk of first-onset clinical depression is increased over menopause.
It added that this can be a vulnerable period for recurrence in those with a history of clinical depression.
It also highlighted that some groups, like those who experience early or cancer treatment-induced menopause, often do not receive optimal care.
Menopause typically starts around the age of 50. Up to 12% of women globally begin menopause between the ages of 40 to 44. Another 2% to 4% of women start menopause even earlier, before the age of 40, and it is dubbed as premature ovarian insufficiency.
Women’s experience of menopause varies hugely, and there is no one-size-fits-all approach to management, the series added.
While many women transition to this stage of life uneventfully, some experience prolonged or severe symptoms and need information, support, or medical treatment.
The most common symptoms associated with menopause include vasomotor symptoms such as hot flashes and night sweats, sleep disturbances, vaginal dryness, and muscle and joint pain.
“But over-medicalisation of menopause and promotion of MHT as a panacea is unhelpful and only serves to divide opinions further. It is time for a sensible conversation about menopause to enable informed, individualised decision-making on optimal management of this transition,” it added.
It said that menopause can also be a time for women to reassess their identities, to embrace this next phase in their lives and the freedom from menstruation and menstrual pain, and to challenge negative perceptions of older women, which are prevalent in some societies.
“We need to send a realistic, balanced message to women and society: menopause does not herald the start of a period of decay and decline but is a developmental life stage that can be negotiated successfully with access to evidence-based information as well as appropriate social and medical support. Women deserve nothing less,” the researchers said.
"The misconception of menopause as always being a medical issue which consistently heralds a decline in physical and mental health should be challenged across the whole of society,” said the series lead author, Prof. Martha Hickey, University of Melbourne and Royal Women’s Hospital, Australia.
She said many women live rewarding lives during and after menopause, contributing to work, family life and broader society. Changing the narrative to view menopause as part of healthy ageing may better empower women to navigate this life stage and reduce fear and trepidation amongst those who have yet to experience it, she added.
For tackling vasomotor symptoms, which affect up to 80% of menopausal women, clinicians can suggest lifestyle interventions, like cutting down on alcohol or smoking and improving sleep habits. Behavioural strategies like cognitive behavioural therapy (CBT) and hypnosis were also deemed effective non-pharmacological vasomotor treatments.
Women going through early menopause and premature ovarian insufficiency may face an increased risk of chronic diseases, including osteoporosis and cardiovascular disease.
“People who enter menopause at younger ages might also experience distress and feel less supported than those who reach menopause at the average age. Clinical practice guidelines are available for the diagnosis and management of premature ovarian insufficiency, but there is a gap in clinical guidance for early menopause,” it added.