What doctors want everyone to stop getting wrong about menopause
Misinformation around menopause is still frustratingly common—among both doctors and patients. We asked experts why you shouldn't believe these five myths.
It’s hard to believe a condition that affects half the human population is so rife with misconceptions. But that is the case with menopause—typically the years from a woman’s mid-40s through the early 50s when hormones fluctuate before falling precipitously as the ovaries stop functioning. Both patients and medical professionals can confuse the facts.
“Women making the menopause transition have more access to information than ever before, but some of it is misguided or misinformed,” says Makeba Williams, a menopause researcher at the University of Illinois College of Medicine.
Some experts blame the stigma around aging that keeps women from sharing their experiences (which is improving but remains). They point to insufficient medical education about the menopause transition, as well as paltry scientific research. But they mostly fault the burgeoning parade of social media experts who offer incorrect or unproven advice.
“Misinformation online is exploding in parallel with the financial ways people can profit,” such as by selling questionable tests or treatments, says Jen Gunter, a gynecologist in
San Francisco and author of The Menopause Manifesto, who addressed the topic at the annual Menopause Society conference last fall.
(What happens during menopause?)
Here are some of the major misconceptions about menopause, and what the science actually reveals.
Myth #1: Everyone experiences similar symptoms
Most women associate menopause with symptoms that experts refer to as the “core four”—hot flashes or night sweats, vaginal dryness, sleep difficulties, and changes in mood. Indeed, these are the most common, with more than 80 percent of women experiencing hot flashes and around a third lacking sufficient moisture in the pelvis.
But numerous other symptoms can also arise from hormonal fluctuations, including itchy skin, sore joints, heart palpitations, dizziness, a burning sensation in the mouth, ringing ears, food intolerance, and others, Williams says.
The full range of symptoms are rarely captured in menopause research, in part because studies tend to be relatively small. In the U.S., studies that observe patients over the course of the transition—the most valuable research—have included some 3,000 women in the largest and a few hundred in others.
Williams herself first grasped that burning mouth could be linked to menopause only four years ago, when a patient complained of it. “When you start looking at the literature, there are estrogen receptors in the mouth, so it makes sense that it could be related,” she says.
Still, before deciding a woman’s symptoms are menopausal, doctors should perform a thorough evaluation to exclude other possible causes, Williams says. Mouth pain could indicate dental issues, for example, while heart palpitations can flag cardiovascular concerns.
Adding to the confusion, the midlife years before menopause, known as perimenopause, are often a time when other medical conditions and personal life challenges arise. These may leave women feeling fatigued, depressed, cognitively foggy, or otherwise out of sorts for reasons unrelated to shifting hormones, Williams says.
Myth #2: Hormone tests can tell you if you’re perimenopausal
Many doctors and telehealth clinics offer to check levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) in midlife women who want to know their perimenopause or fertility status. These pituitary hormones are known to rise during the menopause transition.
But charging for these lab assessments “are a way women are being taken advantage of,” Williams insists, because the numbers from a single test are largely meaningless. “Hormone levels go up and down during this time, so your level now could be different than even an hour from now.”
Instead, the most reliable way to detect perimenopause is by tracking changes in the menstrual cycle. Early in the process, cycle lengths vary from a person’s normal length by around seven days; in the later stage, periods appear two or more months apart. Menopause itself is diagnosed in retrospect, a year after the final period occurs.
On the fertility front, hormone tests fall short as well. Fertility does drop substantially during years a woman is in perimenopause, from some 30 percent odds per menstrual cycle in the 20s to single digits after 40. But conception can still occur regardless of what the hormone tests show, although miscarriage rates for older women surpass 50 percent.
Myth #3: Hormone therapy is too risky for most women during menopause
Hormone therapy is “the most effective treatment for hot flashes” the Menopause Society clearly states in its guidelines. The drugs are especially important for the two-thirds of women whose symptoms interfere with sleep, concentration, and other quality of life issues.
But only a fraction of the women who could benefit are on these treatments, because of mistaken notions they put all women at high risk for breast cancer or other conditions. In one online survey, more than 70 percent of 1500 peri- and post-menopausal women reported experiencing regular hot flashes, yet only 11 percent took hormone medicines. Rates in women who are post-menopause are even lower, below five percent.
The low adoption of the therapy is especially dangerous for women who enter perimenopause before 40, whose dropping estrogen puts them at increased risk of heart and bone health conditions. Only a third of these women are on hormone therapy, according to a study published in January.
In addition to taming hot flashes, hormone therapy can benefit cardiovascular health, since untreated persistent and frequent hot flashes, which can last for years, are linked to increased risks of heart attack, heart failure, or stroke.
Healthy women younger than 60 who are within 10 years of their last menstrual period can safely take the drugs, Menopause Society guidelines state. Women whose health histories preclude them from taking hormones—such as having a prior breast cancer—can reduce hot flashes with other medicines, including recent non-hormonal options targeting temperature-regulating neurons in the brain.
(Is it possible to cure hot flashes? We may be getting closer.)
The higher rates of estrogen in oral contraceptives can also moderate hormone fluctuations and provide an alternative option for perimenopausal women who also want to prevent pregnancy. “We call it birth control, but I wish we had labeled it perimenopause hormone therapy” to emphasize those benefits, Williams says.
Myth #4: Bioidentical hormones are better than pharmaceutical ones
Ads for “natural” or “bioidentical” hormones are all over the internet, touted as better, safer or more effective than pharmaceutical versions. But these marketing terms are meaningless, Gunter says.
“Bioidentical estradiol is just estradiol—it adds nothing to the definition. But people believe it means something different or more special than hormones made by the pharmaceutical companies,” she says. In fact, the only truly naturally made hormone is Premarin, a brand of pharmaceutical estrogen derived from pregnant horse urine. “Every other hormone is made in the lab in a multi-step, complex biochemical process,” including those labeled bioidentical.
Marketers often use these terms to refer to compounded hormone therapy, individually assembled in a local compounding pharmacy. But these medicines lack the rigorously testing of their industry counterparts, which are approved and inspected by the U.S. Food and Drug Administration.
Compounded hormones have yet to prove their effectiveness for hot flashes, a review article published in 2022 concluded; long-term studies are also needed to assess these medicines for heart and cancer risks, the reviewers said. Gunter especially worries about compounded hormones delivered as pellets under the skin, whose dosages can be especially high.
Myth #5: Supplements help menopausal symptoms
Dozens of herbs promise to quell hot flashes or improve perimenopausal mood and sleep. Social media influencers sometimes tout these products, many of which they also sell.
Yet not a single product has proven to be worthwhile. “I wish I could say that we have safe and effective over-the-counter remedies for hot flashes, but we just don’t have the evidence,” says Stephanie Faubion, a top menopause researcher at the Mayo Clinic who is medical director of the Menopause Society.
Studies have found no benefits or mixed results for many popular supplements, most of which have been examined in only a small number of women. For this reason, the Menopause Society does not recommend products with black cohosh, soy, evening primrose, milk thistle, and other herbal substances.
(This is what happens to your brain during menopause.)
Some of these supplements come with their own dangers. Black cohosh, for example, can be toxic to the liver at certain levels. The herb is also frequently mislabeled, with more than a quarter of tested samples found to not contain black cohosh at all.
Despite the lack of data behind supplements, effective non-drug treatments for menopause exist. Several randomized studies have shown that clinical hypnosis sessions significantly reduce hot flashes. Cognitive behavioral therapy can also cut those symptoms, even when conducted online. “There isn’t anything more natural than that,” Gunter says.
