Despite more than a third of women reporting moderate to severe menopause symptoms in 2021, few sought treatment, according to a new study by Mayo Clinic researchers published in Mayo Clinic Proceedings.

Women reported being too busy, unaware of effective treatment and concerned about the safety of hormone therapy as reasons why they didn't seek out treatment to alleviate their symptoms.

The study's findings come during growing awareness of menopause and the drugs that treat it, a welcome change for physicians who see patients with the common condition.

On Nov. 10, the Food and Drug Administration announced it was lifting a black-box warning on hormone therapy drugs used to treat menopause, which warned of an increased risk of heart attack and stroke.

That warning, which was ushered in by a 2002 study conducted by the Women's Health Initiative, dissuaded physicians from prescribing these drugs, shown through research to be safe with some increased risk for certain women with preexisting conditions, such as estrogen-receptor-positive breast cancer and heart disease.

The Women's Health Initiative (WHI) was set up by the National Institutes of Health and U.S. Department of Health and Human Services to increase research into the causes of disease and death in women, but many say that study in particular led to setbacks for women's symptom management.

For one, the study looked at hormones used to treat chronic disease, but using these drugs for menopause got lumped into the public's understanding of their safety and efficacy. The mean age for study participants was 63 years, whereas women under 60 have seen a meaningful reduction in all-cause mortality from these treatments.

"Because of the Women's Health Initiative, for a long time there was a perception that hormone therapy was dangerous, when in fact it matters what risk you bring into it," said Katherine Scruggs, an attending physician at Allegheny Health Network's Midlife Health Center, which treats women in peri- and post-menopause over age 40. She was not involved in the Mayo Clinic study.

WHI responded to the removal of the black-box warning, stating the organization had no position and reasserted its prior stance that oral hormone therapy has risks and should not be used for chronic disease prevention.

"A lot of women for over 20 years have been told that hormones are bad and they should just tough it out," said Scruggs.

The Mayo Clinic survey seems to reflect that.

In 2021, researchers collected survey responses from nearly 5,000 women receiving primary care at four Mayo Clinic sites: Rochester, Minn., Scottsdale, Ariz., Jacksonville, Fla. and Mayo Clinic Health System in northwest Wisconsin. They asked women about their menopausal symptoms, whether they had sought care, the types of treatment they had tried and their interactions with their health care provider.

While more than a third of women reported moderate or severe symptoms, including sleep problems, sexual issues, weight gain and joint pain, most — around 83% — did not seek treatment.

A majority of women reported wanting to treat their symptoms naturally, 1 in 5 said they felt judged by their health care provider and more than 1 in 6 said they were embarrassed by their symptoms.

Researchers expected to see some reluctance in treating menopause symptoms with hormone therapies, but results were starker than they thought.

"The results were very surprising," said Ekta Kapoor, associate professor of medicine at the Mayo Clinic College of Medicine, assistant director for the Mayo Clinic Center for Women's Health and lead author on the paper.

It's an interesting time for the study's release, said Kapoor, with the FDA ruling on the heels of their results. While she said the removal of the black-box warning was "a mixed bag," she worried it will encourage more women to ask for estrogen to be prescribed for unapproved purposes.

While Kapoor stressed that it's essential to reduce fear surrounding hormone therapy, she cautioned that "the pendulum is swinging way to the other direction."

"We're going to have patients in our offices asking for hormone therapy for vitality, for energy, and to reduce the risk of Alzheimer's dementia — all sorts of bogus indications," noting hormone therapy has not been approved to treat those indications.

She took issue with some claims made in the FDA press release and fact sheet, for one stating that hormone therapy can prevent Alzheimer's disease, noting that hasn't been proven and some of the cited studies had small sample sizes or were conducted decades ago, even before the Women's Health Initiative 2002 study on hormone therapy.

Social media has increased awareness about menopause; a positive, but it's also increased misinformation, she said.

It's more common now for women to come into Scruggs' clinic, too, armed with information and a list of questions to ask from internet research. Some women think hormone therapy is "a fountain of youth" and will keep them from aging, she said.

There are some limitations to the Mayo Clinic study; one being that 15% of surveys sent out received responses, and respondents were largely White and highly educated. The researchers called for additional exploration of how women of other races and economic backgrounds may be faring from menopause symptoms.

If researchers were to repeat the study in a more diverse population of women, Kapoor thinks the findings would be even more extreme.

She also hopes to learn more about provider beliefs on hormone therapy to get to the heart of why some are still reluctant to prescribe it. Both she and Scruggs said additional training on menopause and hormone therapies for providers can improve the gap in treatment.

Scruggs hopes the removal of the black-box warning on hormone therapy drugs will further increase uptake of a tool she's seen benefit women's symptom management.

"I do have some hope it's going to get better," she said. "Awareness about menopause is increasing and women are getting better and better at advocating for themselves."

"(Menopause) can cause pretty significant distress in some women," she added. "I always tell my patients, 'Don't suffer.'"

_____

© 2025 the Pittsburgh Post-Gazette. Visit www.post-gazette.com. Distributed by Tribune Content Agency, LLC.