Is menopause over-medicalised?

There are lots of myths and misinformation around menopause, one of which is that HRT (hormone replacement therapy), which is a medicine, is the most widely used and effective treatment for menopause symptoms, yet only 15-20% of menopausal women in the UK take HRT (source: Department of Health). The UK does have one of the highest rates of HRT use across Europe, and for those women who do experience severe menopause symptoms which affect their quality of life, it is now much easier to seek help and HRT through their GP.

However, over 80% of menopausal women don’t take HRT. This is because they choose not to because they don’t have any symptoms, or because they can’t take HRT, or because they effectively manage any symptoms naturally through a combination of changes in diet, lifestyle, exercise, food supplements, and other methods such as Cognitive Behavioural Therapy (CBT). Is HRT therefore really ‘the most effective treatment for menopause symptoms’, as the British Menopause Society (BMS) claim it to be? In the Lancet Series on menopause, it wrote:

‘… the over-medicalisation of menopause and promotion of HRT (sic) as a panacea is unhelpful’.

It also says that the ‘disease-based model’ and a medicalised view of menopause can be disempowering for women, leading to over-treatment. Separate research published in the British Medical Journal says:

‘… medicalisation of menopause fuels negative perceptions and instead of prescribing hormones, clinicians could encourage positive health related behaviours, such as dietary change and physical exercise.' 

Here we explore if menopause is being over-medicalised and what may be contributing to this trend. 

Doctors are not nutritionists

Mainstream education in ‘food and nutrition’ is completely absent in western societies, and this includes medical professionals. GPs and medical doctors, including the British Menopause Society trustees, are medically trained, whether it be as general practitioners, physicians, gynaecologists, obstetricians, or another speciality – they’re not dieticians or nutritionists. Standard training for GPs and medical doctors includes negligible training in food and nutrition. Unless a GP, gynaecologist or ‘menopause expert’ has a separate qualification in nutrition, they’re not qualified to give patients personalised nutrition advice for menopause. They’re also unlikely to be aware of the latest research on food and nutrition, how it can help manage menopause symptoms.

This is not just a problem for women going through menopause; it affects all aspects of healthcare advice that the public receive from GPs, from heart health and gut health to mental health. As Dr Rangan Chatterjee says: "Creating health is different from treating disease. Unfortunately, the vast majority of medical schools teach us only one of these skills, rather than both of them." 

In a recent survey by DR.VEGAN, 90% of people said they expect GPs to be trained in nutrition, and 84% said GPs should offer nutrition advice if it’s a suitable alternative to medication.* Unfortunately they're being let down, GPs are not nutritionists and not qualified to provide adequate nutrition advice. If you’re looking for a nutritionist in your area, we recommend using Nutritionist Resource or contact our Customer Services Team for recommendations. 

Diet and nutrition are very important during menopause

According to a recent House of Lords report, our food system is broken and two-thirds of the UK adult population are overweight or obese, which includes menopausal women. This is vital context for any discussion on menopause because symptoms may be exacerbated by unhealthy diets, high blood sugar levels, excessive weight, high-fat, sugar and salt foods, and ultra-processed foods.

The European Menopause and Andropause Society say 'There is growing evidence diet and physical activity have a significant impact on menopausal symptoms'. Women can get menopause-ready as early as in their thirties by managing their diet and weight, so they can better control menopause symptoms, meaning they may not need supplements, treatment or medication such as HRT through menopause. Learn more in 'Nutrition for the menopause'. 

No definitive accepted list of menopause symptoms

While half the world’s population will go through menopause, there isn’t an accepted, definitive list of menopause symptoms. This absence of consensus makes it easier for people to ‘medicalise’ symptoms. Menopause is different for every woman. It is often said that 25% of women will sail through menopause with no symptoms, 25% will experience severe symptoms, and 50% will be somewhere between the two. The reality is that nobody knows. Even the World Health Organisation, NHS England and NHS Scotland each have different lists of the common symptoms and describe them differently. Some cultures view menopause as a positive rite of passage, while others don’t even have a word for it. 

The lack of research is why we’re passionate about improving education among women and society about menopause. Our survey in 2024 of 1,526 women going through menopause highlighted the most common symptoms and also looked at the impact of menopause on gut health. The top 10 symptoms, of which one or more were experienced by more than 50% of respondents, were:

• Brain fog – 82%
• Mood swings or anxiety – 80%
• Fatigue – 79%
• Hot flushes or night sweats – 75%
• Poor sleep or insomnia – 74%
• Joint aches or pain – 70%
• Weight gain – 69%
• Bloating – 68%
• Low libido – 63%
• Low self-esteem – 57%

Our survey also revealed a further 20 symptoms, from heart palpitations and frequent UTIs to vaginal dryness and gum disease, experienced by up to 40% of women. Learn more in The Menopause Hub. 

Medicines are more profitable

The significant advancements in the awareness and availability of advice, supplements, CBT and HRT for women going through menopause have been a major success in recent years. Menopause is becoming less of a taboo, with women going through menopause receiving more support in the workplace and across society, although there’s a long way to go! Women also have easier access to HRT through their GP, however, there is still disagreement among medical professionals on the levels at which HRT should be prescribed, and much more research is needed in this area.

Food groups such as vegetables, phytoestrogens, whole grains, and healthy fats don’t have their own political lobbyists or the financial backing of pharmaceutical companies. You can’t package, brand and promote foods for menopause in the same way you can do so for medicines like HRT, so there is less financial incentive to promote diet as a way to manage menopause. This may be why, for example, the annual 2024 British Menopause Society Conference, which the BMS hail as ‘the largest menopause event in Europe’, had 17 sponsors and exhibitors who were all pharmaceutical companies. Medicines such as HRT can be branded and promoted to GPs, who are generally not qualified to offer nutrition advice and may recommend medicinal options to women going through menopause.

As a result, the 80% of women going through menopause who choose not to take HRT or cannot take HRT can be left with little or no support to manage their symptoms. This is a structural issue in the UK healthcare system, affecting not just menopause but also other health conditions where people are looking for professional advice on alternative options to medicines.

Diet, lifestyle, food supplements, CBT or HRT?

There is no single remedy that works for every woman or for every symptom - this is a fact. Diet, lifestyle, food supplements, CBT, and HRT, can all help manage and relieve some symptoms of menopause, and for those who experience severe symptoms, a combination of all of these may be required. 

Like any health goal, the first place to start for menopause symptoms is diet and lifestyle. Our mood, ability to concentrate, energy, hot flushes, weight, heart health, muscles and bones, and much more, are all affected by diet, the foods we eat and those we avoid. Here are just a few examples of how foods and nutrients can help manage menopause symptoms:

• A meta-analysis of randomised clinical trials (RCTs) in the Journal of Medicinal Food found that ‘equol’, which is produced from soya, significantly reduced the frequency and severity of hot flushes compared to placebo. Simple changes in diet, such as trying organic tofu, soya milk or edamame beans, can make a significant difference to menopause symptoms.
• An RCT published in the Journal of the Menopause Society (US) found the same beneficial effects of soya when combined with a plant-based diet, reducing moderate to severe hot flashes by 88%.
• One study highlighted the impact of Omega 3 fatty acids on addressing depressive symptoms in middle-aged women.
• A pre-post longitudinal analysis of the Zoe Predict study in peri and postmenopausal women showed a significant decrease in menopause symptoms following changes in diet.

There are hundreds more studies showing how diet can have a positive impact on managing menopause symptoms. Our own survey research in 2024 of 1,526 women going through menopause showed that 91% experienced changes in gut health during menopause, from bloating and excessive wind and gas to constipation, acid reflux and diarrhoea.** 82% said they had made changes to their diet to combat these symptoms, and 66% found these changes effective. Respondents said the most effective changes they observed were:

• Increasing plants and vegetables
• Reducing or avoiding alcohol
• Reducing or avoiding dairy or gluten
• Increasing fibre intake

Not sure what your diet is missing? Create your Diet Profile for free nutritionist advice.

Summary

Has menopause been over-medicalised? On the basis that over 80% of women in the UK don’t choose HRT to manage menopause symptoms, the answer would be no. In addition, the progress in breaking the taboo around menopause in the last few years and the greater understanding and availability of HRT through GPs for those with severe symptoms that can’t be managed naturally, is a great step forward. However, it is also the case that there is limited support and advice through the NHS to manage symptoms naturally, whether that be through diet, lifestyle, exercise, food supplements, or CBT.  

* Survey conducted by DR.VEGAN^® during December 2024, of 195 men and women, nationally representative, through drvegan.com. Not influenced or verified by any third parties.  

** UK survey conducted by DR.VEGAN^® during February 2024, nationally representative. All customer survey findings reflect our own efforts and have not been independently influenced or verified by any external organisations or third-party entities.