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Why are so few women being treated for menopause symptoms? “Rational choice” not high on this story’s list of answers


3 Star


Women are not getting treated for menopausal symptoms

Our Review Summary

hot flashThis story highlights a survey finding that appears to have broadly useful implications for millions of women across the globe: “Many women with severe menopausal symptoms are not being treated for them even though safe, effective remedies are available.” But there’s a tension at the heart of this story that unfortunately is never resolved and which limits the impact of the article. One of the reasons the women mentioned in the story aren’t being treated is because they know that hormone replacement therapy (HRT), the traditional treatment for menopausal symptoms, “can increase the risk of breast cancer, stroke and other serious problems,” as the story acknowledges. The story then suggests that there are alternative approaches, including topical vaginal estrogen therapy and nonhormonal treatments, that are both “safe and effective” and which apparently should be used more often. But the story never backs up the claim that these remedies work and are safe — information that is key to convincing the reader that the story’s claims are true and can be trusted. The story also misses the opportunity to explore how women may feel about menopause and whether some women’s reluctance to be treated reflects a legitimate, informed choice. The assumption seems to be that treatment is clearly the correct choice, but many decline it because they are misinformed. We don’t think that framing reflects the reality of the situation.


Why This Matters

While the symptoms of menopause can be disruptive at times and bothersome, many women may prefer to experience this very natural change of life, cope with symptoms as they come, and not “medicalize” menopause like we have done for so many other normal life experiences. Many women do not want to fill a prescription every month, stress their own budgets, and add to the pharmaceutical companies’ bottom line for relief of symptoms that come and go.  And yes, there is suspicion that the risks are not fully known and that we are still understanding the consequences of treating women for years with HRT. The story does mention, in the last line, that patients “not wanting therapy” is one reason women may not get treated. But a more critical approach to the study might have raised these issues earlier, and made the piece seem less one-sided in favor treatment for symptoms (which notably, are not life threatening and do not necessarily reduce quality of life).


Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The cost of therapies for menopausal symptoms is not discussed. Prempro (the common oral estrogen/progesterone tablet) is $1.65 per pill on an online pharmacy price checker, and must be taken daily — so the cost implications of some options are significant.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story is ostensibly about the findings of a survey which found that women with moderate to severe menopausal symptoms aren’t being treated for those symptoms. While those results are adequately quantified, the story never quantifies the claim, made three times in the text of the article, that alternatives to HRT are “effective” for reducing these symptoms. What evidence supports that claim and what do the numbers say? Which treatments is the story talking about? It refers to “non-hormonal options,” which might include a variety of supplements that are advertised for menopausal symptoms. Such complementary therapies are almost uniformly poorly studied in small, uncontrolled trials. Being more specific here would have been very helpful for readers.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story states several times that alternative therapies for menopausal symptoms, including vaginally applied estrogen, are safe. But elsewhere it acknowledges that pill-based treatment with hormones is associated with increased cancer risk. It would have been reassuring to provide some evidence backing up the claim that these alternative treatments are, in fact, safe — since that seems to be a key reason why women are reluctant to use these therapies. And certainly some of the nonhormonal options for hot flashes (e.g. antidepressant medication) carry a risk for side effects that could have been mentioned.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The story does well at describing the survey in Australia showing that a majority of women do not get treated. But again, there was another side to this story that needed to be explored. There are numerous studies and reviews (such as this one from the Society of Gynecologic Surgeons) that could’ve been used to support and quantify the story’s claims regarding the safety and efficacy of alternative treatments for menopausal symptoms. However, the reader is asked to trust the story’s characterization, since no evidence is cited.

Does the story commit disease-mongering?


The story’s characterization of how many women are suffering from menopausal symptoms seems reasonable. But it does seem a bit skewed toward discussion of women with severe, long-lasting symptoms and doesn’t acknowledge that women may also have milder, transient symptoms that don’t require treatment.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

The story includes comments from an independent expert, but it doesn’t note that the lead study author is a paid consultant to a company that makes an estrogen therapy. (See the disclosure in this recent Medscape article she co-authored.)

Does the story compare the new approach with existing alternatives?


We’ll give the benefit of the doubt here. The story mentions systemic estrogen therapies, topical creams, and non-hormonal treatments. As noted above, we wish there had been more detailed comparisons of these treatments. Even some links telling people where to get more information would have been helpful.

Does the story establish the availability of the treatment/test/product/procedure?


The story establishes that all of the treatments discussed — hormone pills, estrogen creams, and non-hormonal treatments — are available.

Does the story establish the true novelty of the approach?


The story tells readers what’s newsworthy about the results and doesn’t make any inappropriate claims to novelty regarding these therapies.

Does the story appear to rely solely or largely on a news release?


The story includes comments from an independent expert, so we can be sure it went beyond any news release.


Total Score: 5 of 10 Satisfactory

Comments (1)

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Laurence Alter

September 8, 2015 at 8:45 pm

Hormones (and glands!) are what endocrinology is about; thanks for highlighting what should be known and obvious to all: don’t mess around with this part of the body.
Laurence Alter