The Menoverse is exploding

October midlife roundup [2024]

Photo by Yosh Ginsu on Unsplash

Don’t miss the last-minute giveaway at the end of this post

If haven’t heard, the world of menopause has been fraught with news report after news report. That's why I couldn't get this done last week - there was always something else happening.

So let’s get to it, shall we?

The Hormone Therapy Debacle

The BBC recently released a UK-based documentary called Panorama, though I haven’t been able to view it myself as it is restricted to the UK. It’s an investigation into how midlife women are being misled by the menopause industry. You can read more about it here.

The documentary spends some time focusing on supplements but primarily highlights women prescribed high levels of estrogen by a popular UK doctor, Louise Newson. These high doses not only made the women feel worse, but some also developed thickening of the womb and endometrial hyperplasia (a precancerous condition). This approach involves dosing outside the standard of care, for which there is no safety data. According to the report, “100mcg is the level at which manufacturers have established safety and efficacy through clinical trials, which is then approved by the UK’s Medicine and Healthcare Products Regulatory Agency (MHRA).”

The women reported that their estrogen doses continued to increase as they mentioned it wasn’t relieving their symptoms. Some were prescribed up to three times the maximum dose.

Dr. Jen Gunter at The Vajenda recently posted about this, explaining proper dosing regimens. She writes:

I can’t emphasize enough that when someone isn’t responding as expected to a 100 mcg patch, they should also look for other causes. For example, if someone reports they have developed hot flashes again despite being on estrogen and they just started Zoloft, that’s likely the cause. They may need to be tested for diabetes, thyroid disease, and iron deficiency, to name a few.

In response to the concerns, The Menopause Society issued a statement titled “The Menopause Society Statement on Misinformation Surrounding Hormone Therapy,” reiterating that the indications for menopausal hormone therapy do not include the prevention of cardiovascular disease or dementia.

This situation illustrates what happens when all you have is a hammer (estrogen), and everything looks like a nail. But now, testosterone is also in the mix.

The biggest issue here is the lack of informed consent. It’s challenging to provide it when there’s no safety data on such high doses. It’s sad that women were not warned about potential downsides.

The current climate around menopause treatment is so polarizing. Some women have to fight for treatment while others are getting over-treated. It’s crucial to work with healthcare professionals who use studied treatments, but are still open.

And when in doubt, always ask about the evidence supporting the safety and efficacy of any treatment plan.

The Menopause Society Meeting: Speaker Abstracts

Last month was the Menopause Society’s annual meeting. I didn’t attend but reviewed the session summaries and abstracts.

One talk focused on voice changes linked to menopause, with more than 60% of midlife women reporting dysphonia, or abnormal voice. Estrogen-based hormone therapy may help with this, but testosterone can have negative effects, including lowering voice pitch and volume. Such voice changes may indicate early signs of menopause. More research is needed, though I wonder if factors like hydration and blood flow also play important roles. Again, let’s think outside the estrogen box.

Researchers are working on using genetic information to personalize breast cancer risk and screening recommendations. A comprehensive study called WISDOM provides high-risk breast consultations using a specialized tool developed to review risk factors and strategies to reduce risk. They may still be looking for participants, so if you’re interested, you can check it out. Women involved receive a Screening Assignment Letter, genetic testing results, and access to their Breast Health Decision Tool.

“Our overarching goal is to accelerate the earlier identification of those at elevated risk of breast cancer at a young age and/or more aggressive breast cancers, while simultaneously identifying those who are likely to have lower risks for younger/more morbid breast cancers to aid in informed decision-making about breast screening - The Wisdom Study.”

There was also a session on hormone therapy and brain health. Researchers observe mostly neutral effects of hormone therapy on brain health in younger and older women, except for those taking conjugated equine estrogen plus medroxyprogesterone acetate (CEE+MPA), which is associated with a small but significant cognitive decline. Speakers highlighted the lack of large, randomized trials on hormone therapy for women experiencing hot flashes.

Lastly, there was a session on depression during menopause, which differs from depression at other times in life. An “estradiol sensitivity” profile may explain why some women are at increased risk, and there may be a window of opportunity for estrogen-based therapy in midlife. Despite this progress, much work remains to be done.

My top 10 favorite poster presentations

So much new research , so little time. Here are 10 that caught my attention:

• A systematic review and meta-analysis of randomized, placebo-controlled studies showed that hormone therapy significantly reduced insulin resistance in healthy postmenopausal women. Estrogen alone had the most prominent effect.

• Despite all the attention on hormone therapy, its use in the U.S. remains quite low. Among women aged 45-49, 50-54, and 55-59, hormone therapy use decreased from 3.2%, 6%, and 7.3% in 2007 to 1.5%, 3.6%, and 3.8% in 2023, respectively.

• A social media poll of 3,033 women revealed reasons women choose not to take hormones. The top five concerns were: (1) risk of breast cancer (19.89%); (2) difficulty with providers during visits (19.49%); (3) cardiovascular risks (15.69%); (4) feeling dismissed by providers (14.66%); and (5) hormonal side effects such as weight gain (12.13%).

• Researchers examined the relationship between self-compassion and inflammatory biomarkers in 274 midlife women aged 45-67, all free of heart disease. Higher self-compassion was associated with reduced levels of the inflammatory marker IL-6, though not with hsCRP. Self-compassion may be a valuable tool for improving "The One Health Principle.”

• A fascinating study on iron levels and genetics affecting breast cancer risk showed a potentially increased risk in premenopausal women, when estrogen is high, and ferritin is low. However, when estrogen is low and ferritin is high, risk also increases. High ferritin can indicate inflammation rather than true iron status, especially as people age. There may be an optimal middle ground that reduces breast cancer risk, warranting further study. “High E2 and low iron in young women may create a pro-angiogenic environment potentially raising BC recurrence rates. Higher body iron levels may foster a pro-oxidant environment that enhances BC development.”

• Researchers surveyed patients at the St. Joseph’s Healthcare Menopause Clinic in Hamilton, Ontario, about menopause symptoms. Among 501 participants (average age 51.6) attending between January 1, 2021, and June 24, 2024, 41.5% and 50.5% reported moderate/severe bladder issues and vaginal dryness, respectively, yet only 13.8% were receiving local treatments like vaginal estrogen. Over 80% with moderate/severe symptoms were not receiving targeted therapies.

• A scoping review of clinical hypnosis and cognitive behavioral therapy for hot flashes found that both therapies reduced hot flashes, with stronger evidence for hypnosis, which also improved quality of life. Researchers believe hypnosis may alter hypothalamus activity, though more studies are needed.

• A survey of 366 women revealed the top menopause symptoms. While 48% reported hot flashes, brain fog and sleep disturbances topped the list, with 73% reporting brain fog.

• Clinical trials of the S-equol supplement (SE5-OH) in Japan and the U.S. showed positive effects on menopausal symptoms, bone health, and metabolic syndrome. S-equol is a metabolite of soy isoflavones, produced naturally by only 20-30% of Westerners and 50% of Asians, and has estrogen-like activity. This small double-blind, placebo-controlled, randomized crossover study compared the effects of S-equol supplementation (10 mg/day) to a placebo over 12 weeks with 22 non-equol-producing postmenopausal women aged 52-67, who engaged in supervised aerobic exercise 2-3 days per week. After 12 weeks, the S-equol group showed reduced arterial stiffness, improved FMD, and reduced oxidative stress. More on this in a future post!

• The last study looked at sexual function in heterosexual couples aged 50-70. Women with the lowest risk of sexual issues were those with high partner satisfaction, fewer vaginal dryness complaints (73% lower risk), more education (88% lower risk for those with 12 years, and 77% for those with graduation/post-graduation), and partners with better sexual performance (92% lower risk if the partner performed “sometimes/half the time” and 85% lower risk if “most times/always”). Women with partners experiencing erectile issues were 3.6 times more likely to experience sexual function issues.

It's unfortunate there weren’t more studies on micronutrients and breathing research, like the exciting trials by Daniel Craighead. I’ve got an amazing interview coming up on a topic getting little airtime: estrogen and microvascular function!

A last-minute giveaway

Ticket giveaway!

Join The Midst for an empowering in-person (and virtual) conference in Chicago designed for women ready to reclaim their strength and live boldly. Featuring panels on peri/menopause, career and life, and beauty and wellness, this event is geared toward women 35+ who believe that middle age isn't a setback—it's our prime.

For a chance to win a ticket to this event on Saturday October 19th, comment on this Substack post. Winners will be notified by Saturday, October 12th.They are offering two tickets, one in person ($125 value) and the other virtual ($25 value).

In the meantime, let me know how you feel about this menopause explosion!