How the perimenopause movement is hurting women

Two experts say it portrays women as slaves to their hormones — while selling them products they don't need

Torie Bosch: Symptoms such as brain fog, weight gain, hair loss, and insomnia are commonly associated with perimenopause, according to the recent surge in awareness surrounding this transition. However, the proliferation of information raises questions about what is factual versus the misinformation circulating on social media platforms.

Welcome to the "First Opinion Podcast." I am Torie Bosch, the editor of First Opinion, STAT's platform for bold commentary from healthcare professionals, researchers, and patients on critical medical issues. This season, our focus is on the intersection of medicine and culture.

Today, I will be speaking with Patricia Bencivenga and Adriane Fugh-Berman. Patricia is the special projects manager at Pharmed Out, a rational prescribing initiative at Georgetown University Medical Center, while Adriane is a professor at GMUC and the director of Pharmed Out. After a brief break, we will delve into our discussion on perimenopause, menopause, and the implications of viewing women as at the mercy of their hormonal fluctuations.

What is perimenopause?

Patricia Bencivenga and Adriane Fugh-Berman, it’s a pleasure to have you on the "First Opinion Podcast." Adriane, I would like to start with a fundamental question: what exactly constitutes perimenopause?

Adriane Fugh-Berman: "Peri" translates to "around," indicating that perimenopause refers to the time surrounding menopause. While it is typically understood to refer to the years leading up to menopause, the definition is somewhat ambiguous. Some sources suggest that women may begin experiencing perimenopausal symptoms as early as their 30s, meaning there is no universally accepted definition.

Bosch: When did you notice a shift in the discourse surrounding perimenopause?

Fugh-Berman: The concept of perimenopause has existed for two decades but has always been somewhat fluid. We recognize that certain symptoms associated with menopause, such as changes in menstrual cycles, can manifest prior to menopause itself. Many women experience variations in their periods or develop vasomotor symptoms like hot flashes and night sweats before menopause starts. While this has been understood for some time, the more recent trend toward the medicalization of these experiences, suggesting that interventions are necessary prior to menopause, appears to be a newer development.

Bencivenga: I encourage the audience to examine Google search trends; you'll observe a significant increase in interest around 2023 focused on perimenopause.

Bosch: This observation resonates with my own experience. As a 42-year-old, I’ve noted that approximately 75% of my friends aged 35 to 45 have shared that they are navigating perimenopause. Many express that it is profoundly affecting their lives, often attributing various challenges to this transition— even those I attribute to the demands of parenthood or work-related stress. There is a palpable sentiment among women in specific demographics that perimenopause is drastically impacting their quality of life.

The medicalization of a normal transition

Patricia, could you elucidate the arguments presented in your recent thought-provoking essay regarding perimenopause?

Bencivenga: Certainly. A significant concern is the historical perception of women as erratic and unstable due to hormonal changes, a view that has persisted for centuries. Throughout different life stages—puberty, PMS, menstruation, pregnancy, postpartum, and now perimenopause and menopause—women have been viewed through this lens. At what point will society recognize women as stable individuals?

Does the narrative portraying women in perimenopause as chaotic truly benefit us? This inquiry drove my research into the subject.

Bosch: Your article makes a compelling case regarding the misinformation surrounding symptoms attributed to perimenopause. For instance, fatigue, brain fog, and weight gain—Adriane, could you elaborate on the data about the factors contributing to these symptoms?

Fugh-Berman: It is challenging to isolate symptoms that are solely attributable to perimenopause from those stemming from stress, depression, or simply the aging process. Many women wish to attribute weight gain to hormonal changes, but it’s essential to recognize that aging naturally brings such changes. Midlife can often be difficult; women frequently juggle workplace stress, familial responsibilities, and caregiving for both children and aging parents. Attributing all challenges to hormones seems to undermine women's agency and can provide others a rationale to diminish our feelings and experiences.

The perimenopause industry

Bosch: It’s one thing for individuals to declare, "I’m experiencing these symptoms; I must be perimenopausal," regardless of the accuracy of that claim. However, you highlight that this mindset results in tangible consequences, particularly through the emergence of an industry centered around perimenopause. What does this industry currently entail?

Fugh-Berman: Our research has explored the influence of the pharmaceutical industry on medical knowledge, and it’s evident that numerous stakeholders are involved in this emerging industry—beyond just pharmaceutical companies. There are telehealth services, compounding pharmacies, social media influencers marketing compounded hormones, supplements, and various costly medical services. The breadth of this industry is noteworthy, encompassing numerous facets around perimenopause.

Bosch: What types of products are women acquiring in an effort to alleviate symptoms they attribute to perimenopause?

Bencivenga: They are purchasing a range of items, including creams, supplements, and pharmaceutical hormones.

Fugh-Berman: This includes compounded hormones, consultations with healthcare providers, and written materials about perimenopause.

Bencivenga: Also, noteworthy are films and even specialized weighted vests.

Bosch: There are also distinct exercise routines marketed specifically for women in perimenopause as opposed to menopause.

Bencivenga: The current discourse allows for creative marketing aligned with consumer interests, fueled by the heightened awareness around perimenopause. Our experiences and concerns deserve validation, yet the multifaceted complexities of perimenopause extend beyond mere hormonal attribution. Relying on the assumption that a new supplement will resolve our issues might lead to wasted time, energy, and financial resources on interventions lacking substantial evidence.

Bosch: It's crucial to emphasize that the intent here is not to negate the fact that individuals experience genuine discomfort or symptoms affecting their daily lives. The objective is to clarify the underlying causes. It is plausible that someone attributing symptoms to perimenopause may overlook a more serious condition, potentially delaying necessary care.

Bencivenga: Precisely. A particularly alarming example comes from a Wall Street Journal journalist who misattributed a persistent itch to perimenopause, only to discover it was a form of cancer—a tragic outcome.

Mis labeling a cluster of symptoms or even interpreting non-symptoms as indicative of a need for medical intervention can prevent women from considering alternative lifestyle measures that could be more empowering and beneficial during this transitional stage.

The connection to menopause discourse

Bosch: It's interesting to note the rise in discussions around perimenopause appears to coincide with the evolving discourse on menopause itself. Adriane, can you elaborate on how these movements are interconnected and perhaps mutually reinforcing?

Fugh-Berman: Certainly. The perception of menopause as a negative life stage is not new. We observe a cyclical pattern spanning about 30 years: in the 1960s, hormones gained popularity among women to promote youthfulness, but concerns arose linking them to uterine cancer. Following this, there was a resurgence in the 1980s and 1990s where hormones were again promoted as beneficial. However, rigorous studies led by women's health advocates eventually revealed the risks associated with hormone therapy, outweighing its benefits in terms of chronic disease prevention.

It remains established that hormones effectively alleviate hot flashes, night sweats, and vaginal dryness. Yet, claims of hormones addressing an extensive list of menopause or perimenopause symptoms are unfounded and may prevent women from identifying actual underlying causes of their issues.

The Women's Health Initiative and hormone therapy

Bosch: It is essential to clarify that you have served as a paid expert witness in legal cases, including those pertinent to menopausal hormone therapy. Thank you for being transparent about that.

Fugh-Berman: Yes, my involvement has led me to review a substantial amount of internal documents from pharmaceutical companies that detail marketing strategies aimed at shifting perceptions about menopause. This comprehensive PR effort focused on promoting hormones for chronic disease prevention, often lacking empirical support throughout the 1990s. Some of these disclosures can be found in the Drug Industry Document Archive for those interested in examining them.

Bosch: Did any particular revelations from these marketing documents stand out to you?

Fugh-Berman: The findings indicated that pharmaceutical companies influence not only drug information but also shape how diseases and conditions are understood. This pervasive control over medical narratives is troubling.

We've investigated the impact of ghostwritten articles on medical literature that misrepresented the association between hormones and breast cancer. Many of these articles perpetuated the notion that hormones merely expose underlying breast cancer rather than cause it, an assertion with no basis in current evidence. Unfortunately, this pattern of misinformation reemerges, with claims that the previous understanding of hormones and breast cancer is now outdated.

The Women's Health Initiative, a significant longitudinal study, provided conclusive evidence that the risks of hormone therapy—evidenced by increased rates of strokes, pulmonary embolism, and breast and ovarian cancers—outweigh its purported benefits for chronic disease prevention. Notably, upon the dissemination of these findings, millions of women around the world promptly discontinued hormone therapy, reflecting a broader trend in declining breast cancer rates.

Documentaries and medicalization

Bosch: In your essays for First Opinion, you referenced particular documentaries that seem to have perpetuated these narratives. Could you discuss how these films have influenced contemporary discussions about perimenopause and menopause?

Bencivenga: I believe these documentaries contribute to the ongoing medicalization of both menopause and perimenopause, potentially instilling unnecessary anxiety in women about their health. While promoting healthful behaviors is beneficial, it is concerning to frame a natural transition in life with medical terminology.

Fugh-Berman: Regarding "The M Factor," a documentary about menopause, many assertions made within it were misinformed and contradicted existing evidence. Though initially accredited for continuing education, a collective effort from menopause researchers led to the revocation of that accreditation due to outlined misinformation.

Years later, a follow-up film on perimenopause emerged, which contained fewer exaggerated claims but featured distressing anecdotes about women suffering extreme cognitive symptoms linked to the transition. This type of scaremongering is unhelpful.

The reality is that most women experience minimal issues related to perimenopause and many symptoms are likely temporary, resolving as hormones stabilize. It is vital to convey this message of reassurance.

The risk-benefit discussion

The changes women may undergo during this transition are often temporary. While there are ongoing discussions about the potential benefits of hormones for younger women, it is essential to acknowledge that hormone therapy should primarily be considered for those experiencing severe symptoms. Women in their 50s will naturally experience lower rates of heart attacks and strokes relative to older age groups, therefore researchers must exercise caution when interpreting the implications of hormone risks for those in midlife.

Speaking up about misinformation

Bosch: Given that discussions around perimenopause and menopause are prevalent among women, do you often find yourself in social situations where these topics arise? If misinformation is presented, do you actively correct it?

Fugh-Berman: Yes, I have a compulsive tendency not to let misinformation go unchallenged. Observing the pushback against conventional narratives is common; however, we also receive significant backing from healthcare professionals who encounter patients requesting inappropriate interventions.

Lessons from feminist health activism

Bosch: Are there additional insights you hope to share regarding perimenopause and menopause?

Bencivenga: My concern lies in the fact that current narratives often overlook a long history of findings on hormones, particularly insights derived from feminist and women's health activism that have shed light on hormone therapy's effects on our bodies. I fear the oversimplification surrounding the symptoms attributed to perimenopause could regress our understanding. The recent statement from the FDA commissioner championing hormone replacement therapy as a means of saving marriages and preventing depression is troubling; it reflects a misunderstanding of menopause as a natural phase in life.

Fugh-Berman: The more precise terminology would be menopausal hormone therapy (MHT). Despite changes in labeling for vaginal estrogen—which presents distinct risks—the associated harms remain significant. The removal of previous warnings from hormone therapy labels potentially obscures vital information that is crucial for women and their healthcare providers.

Bencivenga: We are in somewhat uncharted territory concerning the application of hormones in perimenopausal and younger women. We must refrain from allowing optimism and hope to substitute for evidence in guiding health outcomes.

The bottom line

Bosch: As we conclude, a pertinent question arises: If a woman recognizes that her discomfort may stem from aging rather than perimenopause, yet feels improved with a product endorsed by an influencer, does it hold significance?

Fugh-Berman: It fundamentally depends on the potential harms associated with that cream, supplement, or compounded hormone regimen. If the product is innocuous and enhances well-being, the only cost may be financial. However, if there are substantial risks involved, it is crucial for women to remain cognizant of potential adverse effects.