U.S. women 'are just feeling really lost about menopause'

From symptoms and risks to average age of onset, a recent study indicates that women have significant knowledge gaps about something they'll all go through: menopause.

An Ohio State University survey, which polled 1,068 women in February, highlights that American women "are just feeling really lost about menopause," said Elizabeth Gandee, an OB-GYN nurse practitioner at the university's Wexner Medical Center in Columbus. It also points a way forward.

"The health care community needs to do a better job of learning about and educating women about menopause," said Gandee.

Of the women surveyed, more than 60% expected to experience their first symptoms of menopause between ages 41-50, and 26% didn't expect symptoms to begin until after age 50.

Meanwhile, the first symptoms of menopause, called perimenopause, sometimes appear as early as the mid-30s, Gandee said.

"Perimenopause is when the menstrual cycle has started to change, and it is persistent," Lauren Baker, an OB-GYN at The Ohio State University Wexner Medical Center and certified practitioner with the Menopause Society, said in an April 8 news release about the study. "The formal definition is periods fluctuate by at least seven days for at least 10 months."

Plenty of patients report feeling not quite themselves, a brain fog and subtle mood changes, but aren't connecting these symptoms with the onset of perimenopause because they're not expecting it to start so early, she said.

In addition, many women don't fully appreciate the health risks that are associated with menopause.

While 95% of the women said they were aware of the possibility of experiencing hot flashes during menopause, other normal symptoms were far lesser known. For example, just 14% knew that heart issues are not uncommon and only 11% were aware that tinnitus, or ringing in the ears, can occur.

Women ages 65 and up were the least likely age group to identify several normal symptoms of menopause, including hair loss, forgetfulness/memory issues and tinnitus, the survey showed.

"So that tells me that we need to provide more education on some of the risks or changes that occur with menopause," Gandee said.

And it's not just patients, but also friends who find themselves in the dark: "I'm in a book club, and 50% of the time is spent talking about the book and 50% of the time, my book club is just picking my brain about menopause."

Treatment options

While medical professionals recommend both diet and exercise modification and hormone replacement therapy (HRT) as safe and effective treatments for most women, these options are not commonly known or accepted as safe by a surprising percentage of women, Gandee said.

"Only a quarter of women identified hormone therapy as safe and effective," she said, adding that health professionals need to do a better job of helping their patients understand that the treatment has been shown to benefit many with minimal health risk.

Women ages 18 to 29 were the least likely to feel that HRT is safe and effective and the most likely to choose diet and exercise to alleviate symptoms, per the survey.

But, said Baker, "There are effective treatments and ways to feel better to not only survive but thrive."

As women approach menopause, their ovaries shrink and stop producing estrogen and progesterone. Not having enough of these hormones in the body is what causes menopausal symptoms. HRT replaces those lost hormones, according to the Cleveland Clinic. HRT can also help with bone loss, a common condition in women who don't have enough estrogen.

Menopause hormone therapy does have risks and could increase the chances of some for: heart disease, stroke, blood clots, breast cancer, gallbladder disease or endometrial cancer. Research suggests that these risks vary depending on age, type of menopause hormone therapy and health history, according to the Mayo Clinic.

Today, there are alternatives available for those who can't or won't try HRT, Gandee said. The variety of non-hormonal treatments for hot flashes includes some antidepressants and gabapentin, typically used for nerve pain. A newer drug, Veozah, was approved by the FDA in 2023 to treat hot flashes. But the key to finding medical treatments is by talking to a doctor about your symptoms, she said.

Especially concerning to Gandee is that so few women identify diet and exercise as being helpful to combat menopause symptoms.

"We definitely would like that number to be a lot higher, because we know that there are a lot of health and lifestyle changes that you can make during the perimenopause and menopause transition that are really beneficial," she said. Increasing calcium and vitamin D intake to combat bone loss, eating plenty of fiber and protein, avoiding excess sugars and alcohol, and prioritizing healthy sleep habits will all help.

"The lifestyle and exercise piece is really important," she said.

Making 'the change'

More education and awareness are key to reducing anxiety about what is a normal part of women's lives as they age, Gandee said. Increased conversations with patients about the symptoms they're experiencing are essential to counterbalance education against unnecessary fear.

"When we give this laundry list of symptoms, like, 'Oh, you're going to have mood changes and sleeping problems and you're going to sweat and it's going to affect your job.' That sounds really scary and horrible, right? But I think that the flip side of this is that we've got adequate treatments, and this is a good time to work on lifestyle changes."

Gandee said there have been other studies, such as "Women's knowledge and attitudes to the menopause," published in BMC Women's Health in August 2023, that have shown the more women learn about menopause, the better experience they have.

Women who live in cultures that value the aging process and their elderly populations also tend to weather the symptoms a bit better, she said. Conversely, in societies that have an exaggerated focus on youthfulness, women tend to report more negative symptoms during that phase of life.

Gandee said she is slowly starting to see more patients who share a more optimistic view of menopause. Many women in their late 30s and 40s are to a point in their lives where "they feel more confident they know what they want out of life" and do not fear the hormonal changes on the horizon.

"There are a lot of women that are really glad that they don't have to worry about contraception anymore. And so I really think that the conversation about menopause needs to be balanced: we need to educate about symptoms, but I think we also need to think about how we're viewing aging and acknowledge that we can age gracefully and that this doesn't have to be miserable and awful."

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