The menopause morass: media, marketing, misinformation

You can't miss the current flood of messages in social media, movies, TV shows, a documentary, news stories and an off-Broadway show.

In my career I’ve written quite a bit about some thorny, complicated, confusing women’s health issues and how they have been communicated to the public. Mammography screening and the often related DCIS (ductal carcinoma in situ) diagnosis immediately come to mind. But today’s topic - the wave of stories about perimenopause and menopause that have recently flooded the mass media - certainly competes for one of the top spots on that list. Some women urged me to write about some of these media messages or else this long piece may never have been written. My intent is to critique the media messages - not the science or the medicine or the opinions of people quoted in those messages - except how they are conveyed by the media messengers. I learned a lot in compiling this post and I hope that you do as well.

This recent Washington Post Style section story drew a robust 939 reader comments before the paper stopped accepting more. Post owner Jeff Bezos must love numbers like that, no matter what the substance of the story or of reader reaction was.

It was a pop culture story, dominated by celebrity stories about Samantha Bee, Halle Berry, Drew Barrymore, Gwyneth Paltrow, Naomi Campbell and Naomi Watts. Some of them peddle their own product lines. The story was also threaded with excerpts from Broadway shows, movies, television shows and novels.

But a Style section story isn’t absolved from standards of good journalism - or from criticism - just because it’s a pop culture feature. And perhaps this is especially true with a story about health care that demands the ABCs of accuracy, balance and completeness.

Many of the 939 reader comments were in disagreement with much of what appeared in the article. Further, some women physicians and researchers who’ve studied perimenopause, treated women in perimenopause, written extensively about it, and educated other women about it for decades found several flawed themes in the story. Key contentions that came out from researchers I contacted were these:

• The “finally someone is paying attention” theme ignores decades of work by researchers and educators.

• No evidence backed up by data is provided in the Style section story. Maybe a little input from the Post’s health care or science teams would have helped. My former HealthNewsReview.org team’s review of 2,600 news stories about interventions showed that only about 35% adequately addressed how big (or small) are the potential benefits and harms from interventions. This is a major flaw in many such stories.

• The Women’s Health Initiative study, which raised concerns about risks from hormone therapy, should not be completely debunked as this story suggests. It is one of the most complicated studies that has been most poorly communicated to the public of any I can recall in my 50 years of health care journalism. And it is inaccurate to publish - unchallenged - the claim that the study marked “the end of menopause education.” Especially when only a single source is cited, and that source has disclosed consulting or other connections with at least 10 drug companies - none of which were mentioned in the story.

“Finally someone is paying attention”

Judy Norsigian is co-founder of the Our Bodies Ourselves organization, co-authors of the pioneering book with that same name starting with the first edition 54 years ago. The organization “inspired the women’s health movement through publishing, collaborating with others to provide services, generate research and policy analysis and organize for social change.” They wrote a single-topic book on menopause in 2006. So it’s understandable that the “finally someone is paying attention” theme rings hollow for people like her.

Norsigian think it’s important to correct the record on the Women’s Health Initiative study and what followed. “Many clinicians did NOT blanketly recommend ‘no more hormones’ but maintained an individualized approach,” said Norsigian. “The final assessment of risk vs benefit should always be up to the individual, not the doctor.”

She balks at statements in the story like: “Menopause education stopped….the world stopped (in 2002) as far as menopause is concerned.”

The story stated: “Many women are enraged because they’re being told they have to grit their teeth and power through perimenopause, without the option to explore potentially beneficial hormone therapy.” (Publisher’s note: The writer should have addressed that quote because it’s misleading; options are available. Instead, unchallenged as it was, it makes the story feel like marketing, not journalism.) Norsigian believes that only “a relatively few docs take the ‘grin and bear it’ approach. The media misrepresent this as well.”

Nanette Santoro, MD, is chair of obstetrics and gynecology at the University of Colorado School of Medicine. She emailed her reactions to me:

“These stories all start out the same way and follow a very tiresome formula:

• Something horrible is happening to women during menopause and the menopause transition;

• No one is paying attention and doctors are completely clueless and incompetent;

• _____(fill in the blank) have all the answers.”

She continued, “The faux indignant nonsense is just becoming a pervasive part of our culture where everyone is being wronged by some dunderheaded enemy and getting all fired up to fight back. Calling social media the middle aged woman’s classroom is truly frightening.“

Nina Coslov is co-founder of Women Living Better, a project that was touted in a recent Lancet journal article, “An empowerment model for managing menopause,” for providing “evidence-based, realistic, and clear information about the menopause transition and its symptoms, including stories from women with lived experience and information about treatment options.” Coslov told me that she believes the “danger in social media is when MDs or influencers talk about perimenopause with 90% accuracy but then go past that into conjecture. And the remaining 10% is not true.”

Others think that the profiteering via social media is a problem. The Post story described one physician “who has parlayed her own social media footprint (almost 80,000 followers on Instagram and 148,000 on TikTok) into a private, cash-pay telehealth practice.”

Follow the menopause money

Nancy Reame, PhD, is Mary Dickey Lindsay Professor Emerita of Disease Prevention and Health Promotion in the Faculty of Nursing at Columbia University. We talked by phone and exchanged emails. She recently wrote in the Journal of The Menopause Society:

“There is no question that the FemTech revolution has discovered menopause. With every click of the mouse or swipe of the screen, advertisements are hard to miss for online treatment options for ‘safe, effective, affordable, ... natural, vegan, plant-based, ...solutions for menopause symptoms, ...delivered right to your door.’ More than just medicines, an array of products like apps and wearables as well as telehealth platforms with health coaches offering tailored menopause ‘relief plans’ are vying for a piece of the burgeoning FemTech market conservatively estimated at 2.5 billion US dollars.”

Reame emphasizes that the variability in women’s symptoms is so large that it leads to broad sweeping advice that confuses and misleads many women. Some may have few, if any, symptoms; some have troublesome symptoms. “It’s pitting women against each other,” she said. This is where news stories and other media messages could help with clarification - but often don’t.

She doesn’t like some of what she’s seen with how physicians have responded. While she thinks there is a short supply of clinicians truly trained in menopause care, “now thousands of doctors want to put on their shingle that they’re a menopause practitioner,” she sighed. She is concerned about the questionable credibility of many who get quoted in the news. She said it is unfortunate that there are a lot of physician-research scientists with ties to drug companies who are chosen to lead big drug industry sponsored trials which drive FDA approval. So they become the all-knowing experts in menopause.” Journalism should disclose these potential conflicts of interest, but news stories often fail to do so.

Reame pointed to “a recent call by experts to demedicalize menopause and reframe it as a normal life process,” along with “the use of impartial noncommercial online tools and resources for evidence-based education and self-managed treatment options as a strategy for empowerment.”

Now that sounds like something worthy of more news coverage and other media attention.

NYT: “The Menopause Queen’s Gambit”

The New York Times also recently published a long article on menopause - actually a long piece on one practitioner, Dr. Mary Claire Haver, who has four million followers on Instagram and TikTok. The story described criticism of the “menopause queen,” explaining that “she has built a multimillion-dollar wellness business, The ’Pause Life, selling supplements and diet plans in a way that some of her colleagues find ethically questionable.” The story did attempt to achieve balance at several points in the long article, stating, for example, that: “Several longtime menopause specialists and researchers told The New York Times they believed Dr. Haver embodied both the promise and perils of menopause care’s next chapter.”

The Times summarizes: “A theme runs through Dr. Haver’s posts: that women’s bodies need estrogen, progesterone and testosterone — all of which plunge during menopause — to function optimally, and that taking them not only can help with symptoms, but also help prevent cardiovascular disease and dementia and contribute to long-term health and happiness. ...The problem is that studies haven’t definitively proven these claims.” Some menopause specialists told the Times that the “cultural messaging about (benefits from hormone therapy was) glossing over the health risks, including for breast cancer and certain cardiovascular diseases, and creating a misguided perception that hormones are essential for a woman’s general well-being as she ages.”

Dr. Jennifer Gunter, an OB-GYN menopause specialist who is also very active and popular on social media criticized Dr. Haver at several points in the piece. An example: “I personally believe that supplements are kind of the road to hell in medicine,” because of their lack of regulation and unfettered promises, Dr. Gunter said. When a doctor promotes a supplement’s benefits based on limited evidence, she said, her feeling is, “why should I trust you on anything else?”

Concerns of a “crisis” of misinformation may be rising. The Times reports, “At the Menopause Society’s annual meeting in Chicago last month, Dr. Stephanie Faubion, the society’s medical director and the director of the Mayo Clinic’s Center for Women’s Health., said she heard numerous whispers from members about what they perceived as a social media-driven disinformation crisis that was promoting solutions lacking in evidence. ‘I’ve never heard this level of alarm and concern,’ Dr. Faubion told The Times.”

The M Factor: Shredding the Silence on Menopause

Last month, 15 experts - most of them women’s health researchers - joined Adriane Fugh-Berman, MD, of the PharmedOut.org program at Georgetown University Medical Center in writing a letter to the Federation of State Medical Boards about “nonstop dangerous disinformation” in a documentary that the Federation had approved for continuing medical education credit for professionals who viewed the program. The FSMB says the matter is under review.

The experts itemized “only” about 15 examples of misleading or inaccurate content in their judgment, claiming that the documentary “contains too many false statements to document here.”

As varied are the opinions on menopause, so was the news coverage of this documentary. Politico posted an unquestioning piece about the documentary. There have been many other such examples. But STAT News published a story summarizing some criticisms of the program. That story included this excerpt:

“…the film also generated a mixed review from Jen Gunter, an obstetrician and gynecologist who writes a high-profile blog about women’s health issues. In a recent post, she praised some segments of the documentary for providing “excellent medical content,” an “outstanding discussion of racial and ethnic differences,” and an“interesting discussion” about menopause in the workplace.

But Gunter was also critical of the film for what she called “problematic content.” She took the documentary to task for lack of nuance about the extent to which menopausal hormone therapies may cause breast cancer. …

Among other complaints, Gunter noted that some of the experts who appeared in the film discussed the use of supplements without being specific about which supplements or why they may be helpful. “I found this general ‘supplements can be great’ narrative especially troubling as several people involved with the documentary profit from the sale of supplements,” she pointed out.

“Sadly, the documentary’s many good points were marred by some significant misinformation, and I believe it’s unacceptable and unfair to put women in a position where good science and helpful information is presented alongside information not supported by the guidelines, especially when we know that the first piece of information people hear is the one they are likely to keep believing,” Gunter concluded.

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My summary, after looking at these various news stories and the documentary, is that more discussion about menopause can be a good thing. But the media-driven discussion could be a much better thing if:

• writers didn’t oversimplify perimenopause and menopause issues. “Everybody wants to know, ‘What should I do?,’ says Nina Coslov of Women Living Better. “And media often try to simplify topics to answer such questions - answers that should not be simplified."

• more messages contained more voices from independent sources - experts who do not have a financial (or intellectual) conflict of interest in the topic;

• more often data - evidence - was provided to back up claims of benefits and harms;

• alternative options were discussed more often - but only if evidence is available.

• writers evaluated the quality of evidence when it is available. Not all studies are equal. Even if study results are published in a peer-reviewed journal, that does not mean that the results are ready for prime time news attention. Why not? Maybe the results are preliminary, from a small trial, over a short period of time, and/or are not generalizable to a broader population. Always read the “limitations” section of a journal article. Observational research should be explained along with its inherent limitations (association does not necessarily establish causation). Opinions and anecdotes are not data. Nanette Santoro, MD, wrote to me: “If you look up the ‘scientific proof’ on (some of the claims made about menopause remedies) you will be in for a fun roller coaster ride of gobbledygook and fuzzy math that will amaze you.”

• writers reminded readers of the wide range of symptoms experienced by different people. As one MD said in “The M Factor” documentary: “You can’t lump menopause into one basket.” But media messages often do just that. And that is a disservice.

• writers looked at the research that showed how “a lack of education leads to misattribution, confusion and fear,” and directly focused on substantive efforts to address this dilemma;

• writers looked ahead to important federal health policy decisions affecting menopause research. For example, what will happen to the funding that had been approved in 2024 for menopause research? Maria Shriver, former first lady of California, said at the time: “I’m not even a betting woman but I’ll bet today that this is the first time a president of the United States has ever signed an executive order that mentions the words ‘menopause’ and ‘women’s midlife health’ in it.” But Nina Coslov of Women Living Better is concerned that “the funding that was approved may now be curtailed.” Journalists should be on top of this issue in 2025.

And consumers of news, as well as consumers of health remedies, should look for the bullet points above to be addressed in the stories you read or watch or hear. If your news source doesn’t regularly address these points, it may be time for you to be enraged enough to move on to another source.