Stanford Statement on March 2024 Lancet Menopause Series

"We need to send a realistic, balanced message to women and to 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 Lancet

The medical journal The Lancet published a 4-article series on menopause this month. The quote above was the concluding statement of an accompanying editorial. Although this statement is inclusive and empowering, many of the positions taken by the authors of the articles, plus the editorial itself, are anything BUT inclusive and empowering. Menopause is repeatedly referred to as “overmedicalized” when in reality, the vast majority of women are left to navigate their perimenopausal and menopausal years with no medical guidance whatsoever. Women struggle to find providers who can partner with them to assess and treat their symptoms and accurately individualize treatment risks and benefits to maximize their long-term health. In a recently published survey of medical trainees, only 7% of OBGYN, internal medicine and family medicine residents felt competent to treat menopausal women–although they acknowledged such care was important.  In the absence of reliable medical guidance, women often turn to “lotions and potions” which lack safety and efficacy data.

Menopause has for too long gone underrecognized, underemphasized, under researched, undertreated, and undertaught, to the detriment of the women we serve. We, the menopause practitioners in Stanford’s Program in Menopause & Healthy Aging, are committed to true women’s empowerment. Our approach stands in contrast to the Lancet authors who describe women’s search for effective treatments as “framing…this natural period of transition as a disease of oestrogen deficiency that can be eased only by replacing the missing hormones [which] fuels negative attitudes toward menopause and exacerbates stigma.”

Although the authors acknowledge that women’s experience of menopause varies hugely and there is no one-size-fits-all approach to management, we reject the idea that treating menopause frames it as a disease.  As women transition through menopause, 80% of them experience hot flashes, up to 68% experience mood instability, and 50% experience joint pain, sleep disturbance, and/or sexual dysfunction. The numbers are even higher if they have experienced early menopause due to medical or surgical conditions.  Moreover, decisions regarding treatment during the early menopausal years can have profound and lasting effects on women’s longterm health and quality of life.  The menopause practitioners of Stanford University strongly believe that empowerment of women rests on the bedrock of hearing women, validating their experience, recognizing the serious risks inherent in undertreatment, and providing evidence-based care—both pharmacologic and non-pharmacologic—to support women’s health and wellbeing through menopause and beyond.

Today President Biden will issue an executive order calling for the most comprehensive set of actions ever to advance women's health research, with a particular focus on women's midlife health and menopause.  As the Lancet editorial notes, historically, women have been poorly served by both the research community and by society. We applaud the administration’s recognition of the knowledge gaps regarding conditions disproportionately affecting women. With longstanding women’s health champions on both sides of the aisle, today’s executive action provides a welcome opportunity to improve research and care for women across the lifespan.
 

Karen E. Adams MD, FACOG, DipABLM, MSCP
Clinical Professor of Obstetrics and Gynecology
Director, Stanford Program in Menopause and Healthy Aging
menopauseandhealthyaging@stanford.edu

Leah Millheiser MD, FACOG, MSCP
Clinical Professor of Obstetrics and Gynecology

Amy Voedisch MD, MS, FACOG, MSCP
Clinical Associate Professor of Obstetrics and Gynecology