MENOPAUSE UPDATE 2025

Flawed studies, a 'critical HT window', vaginal oestrogen, testosterone supplementation and restricted eating are among a rash of hot topics emerging for women gingerly negotiating menopause. Here's what we know now.

- GLYNIS HORNING

Treatment of menopause symptoms has come a long, hard way. In the Middle Ages, many women over 50 with signs of menopause were labelled witches and burnt at the stake, descriptions at trials noting their weak bones, wrinkled skin and, yes, thinning hair (The Discoverie of Witchcraft, 1584). And in Victorian times, doctors like Edward Tilt medicalised menopause, prescribing leeches, stomach plasters of opium and belladonna, and injections of (highly toxic) lead acetate into the vagina.

Today, we're encouraged to see menopause as a natural phase of life, and offered a sometimes confusingly wide range of medical and alternative options to address hot flushes, night sweats, aching joints and bones, mood swings, insomnia, vaginal dryness, low libido, painful intercourse, new-onset unexplained anxiety and depression, and fatigue. By far the hottest contender, at medical conferences and on social media, is hormone replacement therapy (HRT) - now known as HT (hormone therapy) or MHT (menopausal hormonal therapy). As the International Menopause Society put it in September 2024 in a white paper titled 'Menopause and MHT in 2024', 'Menopause and MHT continue to be topics of considerable controversy and debate, to the detriment of many women and society as a whole'.

HT was approved by the US Food and Drug Administration (FDA) in the 1940s and marketed as a 'cure' for menopause. From the Swinging Sixties to the Naughty Nineties, women embraced it for their hot flushes and vaginal dryness. But excitement turned to fear in 2002 when administrators of the Women's Health Initiative (WHI) study of 160 000 women aged 50 to 79, the largest such project in the US, abruptly stopped it. Although HT had benefits, they said, these were outweighed by a raised risk of blood clots, stroke and breast cancer.