Menopause specialists are pushing back on a familiar midlife sales pitch: that a blood test, an app, a supplement stack, or a demand for hormone replacement therapy can settle whether a woman is in perimenopause and fix whatever feels wrong.
Perimenopause is the stretch before menopause, which is defined as the point one year after a person’s final period. It can last for years and often brings symptoms associated with menopause, including hot flashes, irregular or heavy periods, and anxiety. Mary Ann Lumsden, a former president of the International Menopause Society, told MIT Technology Review that symptoms are often most severe during perimenopause.
The biology is messy. Lumsden said levels of estrogen, progesterone, luteinizing hormone, and follicle-stimulating hormone can swing sharply during this stage before stabilizing after menopause. That volatility is why she says hormone measurements do not provide a reliable perimenopause test.
“You can’t interpret hormone [measures] because they change so much,” Lumsden said. “And that is quite normal.”
Hormone therapy is not a universal answer
Hormone replacement therapy, or HRT, is meant to replace or supplement hormones such as estrogen and progesterone as they decline around menopause. Lumsden said it can help many menopausal women with common symptoms, and can also support bone health and muscle strength. The treatment carries risks and is not suitable for everyone.
The catch, according to Lumsden, is that the drugs were tested in and approved for menopausal women. Perimenopause is different because a woman’s own hormone production may still be fluctuating. Lumsden said standard HRT can be “swamped” by those internal hormone swings.
Paula Briggs, a former chair of the British Menopause Society who leads the menopause service at Liverpool Women’s Hospital, said HRT can cause abnormal bleeding in perimenopausal women. She also warned that social media has promoted the idea that younger women should identify themselves as perimenopausal and seek HRT.
“It’s almost cult-like, this idea that everybody must have HRT,” Briggs said.
Supplements face the same evidence problem
Marketing for vitamins and supplements aimed at middle-aged and menopausal women has grown rapidly, according to the report. Lumsden said evidence for many of those products is limited or absent, and that she cannot identify a plausible mechanism for many of them.
She described patients who said they were taking testosterone supplements for symptoms, but blood tests showed no increase in testosterone. “Whatever they’re getting, it’s not testosterone,” Lumsden said.
The symptom lists circulating online can also stretch far beyond the changes most clearly tied to menopause. Fatigue, brain fog, aches, digestive problems, and other complaints may appear in midlife, but Nanette Santoro, a professor of obstetrics and gynecology at the University of Colorado Anschutz who studies menopause, said those symptoms do not closely track menstrual-cycle and hormone changes across menopause.
Experts cited in the report said symptoms should be assessed so other causes are not missed. Lumsden noted that endometriosis, for example, can be worsened by HRT. Santoro put the broader warning plainly: “Attributing everything unpleasant that happens to a woman over 35 to perimenopause is not based on any scientific evidence.”
This story draws on original reporting from MIT Technology Review.