Shine a light on the need for visionaries
 

Menopause is a natural transition that everyone female at birth goes through—more than 47 million women enter menopause each year globally.¹ Yet it is still often regarded as a taboo topic, and feels like the next thing in a woman’s life that she just needs to “get on with.” This can have a high emotional impact for women as menopause marks the end of a woman’s reproductive life – sometimes making her feel less of a woman or making her feel old.

Menopause brings a variety of symptoms that can range from hot flashes, night sweats, and vaginal dryness to mood swings, depression, and anxiety. About 30% to 50% of all women experience menopausal symptoms that affect their quality of life and can impact their confidence and relationships.

In addition, the physical consequences of menopause can include bone loss, increased central abdominal fat, and adverse changes in a woman’s cholesterol profile and vascular function. These changes predispose postmenopausal women to increased risks of osteoporosis and bone fracture and of cardiometabolic diseases (eg, diabetes and cardiovascular disease).

All of those symptoms stand in huge contrast to the stage in a woman’s life. Surveys show that women aged 50+ know what they want and are more self-confident. Their search for meaning is complete. Women over 50 are often more settled; they earn more, have established careers, own property, and have stable home lives. A woman over 50 knows what she can and can’t do; she know who she is and who she is not. 

 

So what is she looking for and what would help to make this life transition easier?
 

During the transition, women often look for support from their doctors, pharmacists, or friends. While it can be a burden for women, it can also be seen as a burden for healthcare professionals, such as general practitioners (GPs), nurses, pharmacists, and obstetricians/gynecologists (OB-GYNs)—training and education on menopause is alarmingly low, despite its vast prevalence.

According to experts, many common symptoms of menopause are too often not properly diagnosed and treated; these include not only hot flashes, sweating, irritability, and depression, but also sleep disorders and joint pain.

For example, many women with depressive moods are sent home with an antidepressant. “Only 14 percent of those affected are diagnosed with ‘menopausal syndrome’,” says Prof. Petra Stute, Senior Physician and Deputy Chief Physician of Gynecological Endocrinology and Reproductive Medicine, University Clinic for Gynecology, Bern.

Encouragingly, we can see some changes starting to come through. In the United Kingdom, as of April 2023, women can get a pre-payment certificate for most menopause products. However, many governments still don’t have health policies in place and lack financial support for the inclusion of menopause among covered conditions. Regarding care and billing, there is a billing number in Germany for perimenopausal conditions, but professionals, including gynecologists, are not incentivized or reimbursed for consulting on menopausal symptoms.

More than 41% of UK medical schools don’t have menopause as part of the mandatory curriculum, and 80% of graduating US internal medicine residents do not feel competent to discuss or treat menopause. Only 20% of US OB/GYN residencies offer menopause training.
 

The internet as a bad advisor
 

Many HCPs feel abandoned in their struggle to find the right treatment options and select the right options based on their patient’s individual needs. They might not feel equipped to effectively discuss menopause treatment options and enter into a Shared Decision Making conversation.

Collaboration between GPs and gynecologists is essential to provide women with the best possible care during menopause.

GPs are often the first point of contact for women seeking help with menopause symptoms, and they can refer women to a gynecologist for specialist care if needed. Gynecologists can work with GPs to develop individualized treatment plans that address each woman’s unique needs and preferences.

Throughout menopause, women switch with striking frequency between different HCPs to have meaningful gynecologic consultations. Many women feel alone and resort to searching and sharing treatment options with their peers on social media. But the tone there varies between frustration and irony or sometimes even sarcasm.
 

The two faces of social media
 

As with many things, social media can be a force for good or ill. Platforms like Instagram or Twitter can break the taboo of menopause by allowing users to talk about their experiences, interact with others, and feel less alone. They can help to normalize this phase of life and make it part of everyday conversation. The online disinhibition effect facilitates the sharing of anxieties, experiences, and tips. Provided this is not positioned as medical advice, support through social media eases the sense of isolation and often encourages people to contact their doctor. Further, social media is a vital campaigning tool for menopause activists, like the grassroots campaign #MakeMenopauseMatter.

But differences of opinion can also escalate into unhelpful online jousting, and conflicting information on the internet can create yet more confusion for patients. The dark side of the online disinhibition effect is that it can lead to social media spaces becoming toxic.

Misinformation is liberally shared on social media, either unintentionally or sometimes for commercial gain, with 16% of Instagram posts with #menopause advertising services or products. Additionally, social media thrives on sound bites; nuanced studies are simplified and frequently misrepresented. Personal or anecdotal experiences are conflated with evidence, and GPs are sometimes discredited. Social media platforms are unregulated businesses and it is often difficult for women to know what information comes from a trustworthy source.

Often nuance equity, inclusion, and diversity of experience are not represented, and medics on social media are usually very rare. One exception in the United Kingdom is Dr. Nighat Arif, a GP specializing in women’s health and family planning with over 15 years of experience in the National Health Service (NHS) and private practice who raises awareness on menopause and healthcare in Black and Asian women. Based in Buckinghamshire, she is able to consult fluently with patients in Urdu and Punjabi, reaching a much wider group of women via social media. Dr. Nighat is very active on Instagram and TikTok; her posts range from “Tips for HRT” to general advice on menopause. But she is more the exception than the rule.

Current treatment options
 

The current go-to treatment option is Hormone Replacement Therapy (HRT), which can help alleviate menopause symptoms by replacing the hormones that the body no longer produces. However, there are different types of HRT and it may not be suitable for every woman.

HRT can also carry some risks, including increased risk of breast cancer and blood clots, which need to be explained in an informed Shared Decision Making discussion. Given the potential risks associated with HRT, it is essential that women receive personalized information, care, family history review and guidance from their healthcare providers. Gynecologists are specialists in women’s reproductive health and they are uniquely positioned to provide expert advice and support to women going through menopause. Gynecologists can help women to understand the benefits and risks of HRT and provide guidance on other treatment options, including non-hormonal therapies, lifestyle changes, and complementary and alternative therapies.

To feel comfortable doing this, GPs, nurses, pharmacists, and OB-GYNs need training to engage in open Shared Decision Making conversations with women in perimenopause. There is a large opportunity for pharma and healthcare companies to address and reduce menopause stigma to drive better engagement and more effective treatment plans. Women need products to treat their specific menopausal symptoms, and the world needs a brand courageous enough to address the societal stigma associated with menopause. 

Menopause is a complex and multi-faceted issue that requires a holistic approach
 

Pharma companies and their brands can help fight stigma around menopause and ensure that all women receive the right treatment and trustworthy information.

They can form collaborations with health insurers and doctors to put the issue on the agenda in the doctor‘s office and on social media. And together with the public, including journalists, non-governmental organizations (NGOs) and international organizations, they can stimulate research, educate, and contribute to a new discourse. 

Together, this alliance can ensure that policymakers turn more attention to the issue again; invest in the education of physicians, OB-GYNs, nurses, and pharmacists; and firmly integrate the topic into university curricula to ensure menopause becomes an integral part of the training of GPs and other healthcare professionals, to enable them to provide personalized care that addresses women’s specific symptoms and needs. 

Social media can be a source of trustworthy information from trained experts first and foremost, including physicians, medical associations, health insurance companies, Patient Advocacy Groups, and other NGOs. However, the accuracy and relevance of information on social media should not be left to the masses, and public awareness of kitemarks signifying trustworthy information should be raised. Examples include initiatives like PIF TICK in the United Kingdom, a quality mark for print and online patient health information. So patients and the public can be assured that what they are reading, watching, or listening to is evidence-based, easy to digest, up to date, and produced to the best possible standard. Pharmaceutical companies and their brands have a unique opportunity to support women in this important stage of their lives.

At a time when women‘s health is in the spotlight, we all have an opportunity – actually, an obligation – to shine a light on the burden of menopause and women’s experiences. We need to raise awareness of the challenges that women face during this transition and the importance of effective management of menopausal symptoms. We also need to recognize the role that gynecologists and the broader healthcare professional team can play in supporting women on their menopause journey. 

Menopause is a natural and inevitable part of every woman’s life. By working together, we can ensure that women have the support they need to navigate this transition successfully and make informed decisions that are right for them as individuals. Let us embrace menopause as a normal and natural process, and provide women with the trustworthy resources and support they need to manage this stage of life with confidence and ease.

^{1 Most personal experiences of menopause involve cisgender women (those who were born and identify as women), but transgender men and some people who identify as neither men nor women may also experience menopause. All people have unique age-related health needs that clinicians and businesses should consider when developing treatment and support solutions.}

If you are interested in embarking on this journey together please reach out to inka.ficht@ipghealth.com and linda.cowie@solved.health. 

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