Jody Tate

The silence surrounding menopause is putting women’s lives at risk

1 June 2023

dictionary with the definition of menopause highlighted

The stigma surrounding menopause not only impacts women’s wellbeing and quality of life, but also puts their long-term health at risk.

Menopause is a natural transition starting a year after a woman’s* last menstrual cycle. It typically occurs between the ages of 45 and 55 and involves a significant decline in the hormone oestrogen. Although it affects about half of the world’s population, ageism and sexism are contributing to a veil of silence around menopause that runs the risk of leaving some women feeling excluded and alone.

Menopause can have a devastating and long-term impact on women’s health and wellbeing

Menopause can be a critical turning point for a woman’s health, both physical and mental. This transition can be associated with an array of symptoms, ranging from the uncomfortable or irritating to the potentially life-altering.

Some of the tell-tale signs of menopause, such as night sweats and hot flushes, are well known, but many people are unaware of some of the more sinister symptoms. These include brain fog, memory problems, anxiety and depression, which can either be due to hormonal changes or result from the impact of other symptoms of menopause on mental health. These symptoms can be so severe that relationships break down, regular work becomes unsustainable or women feel the need to make other drastic life changes.

Menopause can also lead to physical changes, with a significant impact on long-term health outcomes. For instance, increases in insulin resistance, fat accumulation and cholesterol levels can raise the risk of cardiovascular disease, while changing hormone levels can lead to weakened bones, increasing the risk of osteoporosis.

Some of the tell-tale signs of menopause, such as night sweats and hot flushes, are well known, but many people are unaware of some of the more sinister symptoms, including brain fog, memory problems, anxiety and depression.

Menopausal hormone therapy can address the short- and long-term impacts of menopause, but many women are not able to access it

For many women, menopausal hormone therapy can be transformational in relieving symptoms and improving quality of life. Menopausal hormone therapy can also help prevent cardiovascular disease and osteoporosis. But it is not suitable for all women and clinical guidelines recommend an individualised approach to treatment that takes into account a broad range of risk factors. Ideally, healthcare professionals should provide enough information about menopausal hormone therapy that women can decide for themselves whether or not to use it.

Many women are not able to access the treatment they need. A UK survey of more than 5,000 women experiencing menopause or perimenopause found that although 79% visited their GP about menopause symptoms, only 37% were given menopausal hormone therapy. Despite national menopause guidelines clearly stating that antidepressants are not a suitable first-line treatment, 23% of the women were prescribed them instead.

The survey also highlighted significant delays in care, with 44% of the women who received treatment waiting a year or longer, and 12% waiting more than five years. As a result of this waiting time, many women who can afford to pay for healthcare turn to private clinics, contributing to health inequalities.

These challenges are worrying for all women, but they may disproportionately affect those belonging to ethnic minority groups and LGBTQ+ communities. These individuals have reported having negative experiences when seeking appropriate care and feeling under-represented in the research and narratives surrounding menopause.

Stigma, shame and a lack of representation contribute to low awareness of symptoms and a hesitancy to seek care

Women experiencing menopause can only get support and treatment if they recognise the symptoms and know to reach out to a healthcare professional for advice and information. However, many women are not aware of what to expect from menopause and do not feel well informed.

This may be due in part to a huge void in the public and cultural discourse around menopause. Rarely is menopause mentioned in films or television, which may make the women who are experiencing it feel invisible. It may also mean that some women do not recognise their symptoms as menopause related.

Alongside the stigma and shame around menopause, and around ageing more broadly, this lack of knowledge can be a barrier to seeking care.

Gaps in knowledge about menopause among healthcare professionals are exacerbating the problem. In fact, an unacceptable 40% of the UK’s medical schools that responded to a 2021 survey do not include mandatory menopause education as part of their curriculum. Instead, they assume that healthcare professionals will receive this education during their early years of medical practice, which may not always be the case.

This means that accessing appropriate treatment and care for menopause is often not straightforward.

Two black women's hands holding each other's in a supportive way

Alongside the stigma and shame around menopause, and around ageing more broadly, this lack of knowledge can be a barrier to seeking care.

We have to address the stigma surrounding menopause and ensure all women receive the care they need

Given how significantly menopause can affect the long-term health of women, it is essential that healthcare professionals provide all women, regardless of their background and personal characteristics, with information, support and evidence-based treatments that meet their specific needs.

As a society, we must also address the feelings of stigma and shame around menopause, which stem from pervasive and entrenched sexism and ageism. Improved awareness of the symptoms and better care provision during menopause will ultimately lead to better health and a higher quality of life for millions of women.

* As people generally associate menopause with cisgender women, we have used the terms ‘woman’ and ‘women’ throughout. However, we recognise that menopause can affect people of all genders and that menopausal hormone therapy also has an essential role in transgender healthcare.

The silence surrounding menopause is putting women’s lives at risk

The stigma surrounding menopause not only impacts women’s wellbeing and quality of life, but also puts their long-term health at risk.

Menopause can have a devastating and long-term impact on women’s health and wellbeing

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Menopausal hormone therapy can address the short- and long-term impacts of menopause, but many women are not able to access it

Stigma, shame and a lack of representation contribute to low awareness of symptoms and a hesitancy to seek care

We have to address the stigma surrounding menopause and ensure all women receive the care they need

The opinions expressed in this blog are those of the author and do not necessarily represent the views of The Health Policy Partnership.