Menopause Symptoms Affect Millions of Women. They Need Evidence-Based Guidance.

Every year approximately 1.3 million American women enter menopause. Many women in perimenopause and menopause experience symptoms that affect their quality of life and productivity at work. Despite the millions of women who could benefit, a historical lack of funding for research in women’s health issues—combined with multiple controversies surrounding the use of hormone therapies—leaves women with few rigorously studied menopause treatment options. Meanwhile, a recent AARP analysis gives insight into health care-seeking behaviors of women experiencing menopause.

Menopause and how it’s treated today

Menopause, defined as the cessation of menstruation for at least 12 consecutive months, usually occurs in women ages 45-56. However, about 5% of women experience early menopause prior to age 45. Although menopause is not a disease, the declining estrogen levels associated with menopause can cause uncomfortable vasomotor (e.g., hot flashes, night sweats) and genitourinary (e.g., vaginal dryness, urinary tract infections) symptoms in many women. Indeed, a recent AARP survey found that 90% of women in menopause experience at least one symptom, with most women reporting five or more symptoms.

In an analysis of data from the Medical Expenditure Panel Survey (MEPS), the AARP Public Policy Institute and NORC at the University of Chicago found that each year from 2016 to 2021, an estimated 2.1 million women between the ages of 45 and 64 sought treatment for their menopausal symptoms. The most common treatment was hormone replacement therapy (HRT), a collection of estrogen, progesterone, or both hormone treatments. Over 1.4 million women, or approximately two-thirds (65%) of women seeking treatment for menopause in the U.S., received an HRT prescription. Selective serotonin reuptake inhibitor (SSRI) antidepressants, one of which is approved by the Food & Drug Administration (FDA) to help control vasomotor symptoms, were the second most common treatment prescribed to menopausal women, with 15% of those seeking treatment for menopausal symptoms receiving an SSRI prescription.

Our MEPS analysis was based on encounters women had with the health care system but likely missed women who discussed menopause with their providers but did not receive treatment. Additionally, MEPS does not capture non-medical complementary and alternative treatments women may have accessed, such as acupuncture and unregulated herbal supplements. The AARP survey found that women are much more likely to try non-medical than medical treatments, with supplements and vitamins being the most popular. In fact, as many menopausal women seek relief from cannabis as HRT.

HRT’s rocky history

Many experts and professional societies believe that the benefits of HRT outweigh its risks, but scientific consensus has undergone several reversals over the past six decades. The first HRT treatment—a combined estrogen-progesterone therapy—became widely available for menopausal women in the 1960s. Three decades later the Women’s Health Initiative (WHI), a collection of large federally funded clinical trials, was initiated, in part to study the effects of hormone therapies on heart disease and cancer risk. The HRT studies, however, were stopped early, based on interim analyses suggesting HRT increased the risk of heart disease, stroke, and breast cancer. As a result of these findings and the public alarm that followed, many clinicians stopped prescribing HRT. The number of women able to access HRT dropped dramatically. After considerable debate about the conclusions drawn from the WHI HRT studies, re-analyses of the WHI trial data were conducted in 2017 and 2024, essentially reversing its original conclusions.

Federal government attention on the rise

Encouragingly, women’s health and menopause are gaining attention at the federal level. In the past year, both the White House and the Department of Defense announced initiatives to fund women’s health research. In Congress, several bills designed to improve the health of women experiencing menopause were introduced, including the Advancing Menopause Care and Mid-Life Women’s Health Act (S. 4246/ H.R. 8233). This legislation would expand federal funding for research on menopause detection, diagnosis, and treatment, as well as to better train doctors about menopause and increase public awareness. AARP has endorsed this legislation.

Still lacking: rigorous HRT research

Scientists now believe that for women who decide to take HRT, starting early in menopause or before turning 60 will help them reap the most benefits from the treatment. However, a large clinical trial on women starting HRT in their 40s and 50s and following them for at least a decade has never been conducted. In addition to the need for such a trial, since HRT is available in multiple formulations, conducting studies on the safety and efficacy of different types of HRT are also paramount.

More research funding is needed to fully understand the risks and benefits of available hormonal and non-hormonal interventions and to discover new treatments for menopausal symptoms. Social, psychological, and physical health interventions during menopause should be an integral part of health care. Women in midlife must have the opportunity to receive medical care from clinicians who are trained to address the health concerns common to this phase of life.