Menopause is universal. Women make up around half of the world’s population and, for those who live to midlife, menopause is an inevitable biological transition. It is not a rare condition, an illness or a niche health issue. It is something experienced by billions of women across generations.
The hormonal transition is biological.
And yet, for generations, menopause has been wrapped in the language of things disappearing: hormones, fertility, youth, beauty, sexuality and, somewhere beneath all of that, a woman’s perceived value.
At the same time, women were receiving an almost completely contradictory message. Menopause was natural, they were told. It happened to everyone. Get on with it.
And so hot flushes, sleepless nights, anxiety, brain fog, vaginal and urinary symptoms, changing bodies and lives turned upside down were often whispered about, joked about, endured and ignored.
Somehow we arrived at a narrative that managed to tell women both that their bodies were failing and that they really shouldn’t make such a fuss about it.
Then, in 2002, the Women’s Health Initiative (WHI) published findings that profoundly changed the menopause landscape. The study linked the particular combined hormone regimen it tested — conjugated equine estrogens with the synthetic progestin medroxyprogesterone acetate — with increased risks including breast cancer, stroke and blood clots.
There were major concerns to applying these findings. The average participant was around 63, many were years beyond menopause, and the hormones studied were different from the body-identical 17β-estradiol and micronised progesterone widely used today. The risks identified in the combined WHI trial related to the particular regimen that was studied; they should not be assumed to apply identically to every form of hormone therapy.
Yet these crucial distinctions were largely lost.
The findings from this study became widely translated into a sweeping message that HRT itself caused breast cancer and was dangerous. Headlines amplified the fear, prescribing plummeted and a generation — arguably two — of women entered menopause believing hormone therapy should be avoided.
More than twenty years later, the consequences remain.
Outdated interpretations of a study published more than two decades ago should not still be determining the choices available to women today.
Hormone therapy may not be right for every woman, but women deserve the opportunity to consider it using current evidence and their individual circumstances. They deserve knowledgeable healthcare professionals, informed conversations and the ability to make decisions without carrying forward a legacy of fear.
Nor do we need to swing wildly in the opposite direction and declare menopause a “superpower”. That simply creates another expectation for women to live up to. Menopause can be liberating for one woman and extraordinarily difficult for another. It can even be both for the same woman at different times.
There is room for all of those experiences.
What we need is a menopause narrative that is informed rather than fearful, individual rather than prescriptive and honest about both the challenges and the possibilities of this stage of life.
The biology may be written into us.
The story is still ours to write.
And perhaps it is time we wrote a better one.
