News
Women warned against spending money on ‘unnecessary’ menopause services
Women going through the menopause are being cautioned against spending money on direct-to-consumer menopause services that may provide little benefit.
A group of doctors raised concerns about overstated hormone therapy claims, aggressive promotion of supplements and tests, and marketing presented as advocacy.
They argue that commercial menopause services raise questions about reliability and the risk of bias in the information given to women seeking symptom relief.
Dr Marie K Christakis of the University of Toronto, Dr Taylor Roebotham of Sinai Health, Dr Stephanie Sterry, an NHS GP, and Dr Olexandra Koshkina of the University of Toronto, highlighted hormone panel testing as “one of the most troubling trends”.
Christakis said: “We wrote this piece because although we are excited by increasing discussion around menopause care, we are seeing a surge of confusing and sometimes misleading information.
“This leaves many women unsure of what to believe and can result in either undertreatment or use of unproven approaches.
“We wanted to encourage and support healthcare professionals in providing evidence-based care.”
Hormone panel tests can cost hundreds of US dollars and are promoted as essential for tailoring hormone therapy.
But doctors say they have limited clinical use because there is no clearly defined treatment range for menopausal hormone therapy (MHT), and some testing methods do not accurately measure hormone levels.
Christakis said: “Testing can be expensive, misleading and may push women toward unnecessary treatments.
“Alternatively, it can be used as a justification to withhold treatment from women with debilitating perimenopausal symptoms before they experience a steep, steady drop in their hormone levels.”
Hormone testing cannot reliably identify who will benefit from treatment, when a final menstrual period will occur, or when contraception can safely stop.
Clinical guidelines from the British Menopause Society, National Institute for Health and Care Excellence, American College of Obstetricians and Gynecologists, The Menopause Society and Endocrine Society agree: for women over 45 with recognised menopausal symptoms such as menstrual irregularity, diagnosis should be clinical and testing is not needed.
Despite this, many women purchase detailed hormone panels from wellness clinics or online providers.
Results are often used to justify custom-made hormone preparations or supplements based on small differences in hormone levels that lack an evidence base.
Christakis added: “Commercial bias arises when products or services are marketed under the guise of advocacy or education.
“This can mislead women into thinking something is evidence-based or endorsed by experts when it isn’t backed by guiding medical organisations.”
Custom-made hormone preparations, known as compounded bioidentical hormone therapy, are not regulated like standard MHT.
The authors warned that inconsistent doses of oestrogen or progestogen could lead to endometrial hyperplasia – abnormal thickening of the womb lining – or even cancer, particularly in women with an intact uterus given inadequate progestogen.
Christakis stressed the importance of tailored care: “This means taking time to listen to each woman’s symptoms, medical history, and preferences, then tailoring care accordingly.
“We hope to encourage primary care providers to engage in shared decision-making with women and to integrate best available evidence.
“Lab results don’t capture the full experience of menopause.
“Listening allows clinicians to understand the impact symptoms are having on a woman’s daily life and wellbeing.
“Effective treatment starts with that conversation, then uses evidence-based options to support her needs.”
Diagnosis
Lung cancer drug shows breast cancer potential
Ovarian cancer cells quickly activate survival responses after PARP inhibitor treatment, and a lung cancer drug could help block this, research suggests.
PARP inhibitors are a common treatment for ovarian cancer, particularly in tumours with faulty DNA repair. They stop cancer cells fixing DNA damage, which leads to cell death, but many tumours later stop responding.
Researchers identified a way cancer cells may survive PARP inhibitor treatment from the outset, pointing to a potential way to block that response. A Mayo Clinic team found ovarian cancer cells rapidly switch on a pro-survival programme after exposure to PARP inhibitors. A key driver is FRA1, a transcription factor (a protein that turns genes on and off) that helps cancer cells adapt and avoid death.
The team then tested whether brigatinib, a drug approved for certain lung cancers, could block this response and boost the effect of PARP inhibitors. Brigatinib was chosen because it inhibits multiple signalling pathways involved in cancer cell survival.
In laboratory studies, combining brigatinib with a PARP inhibitor was more effective than either treatment alone. Notably, the effect was seen in cancer cells but not normal cells, suggesting a more targeted approach.
Brigatinib also appeared to act in an unexpected way. Rather than working through the usual DNA repair routes, it shut down two signalling molecules, FAK and EPHA2, that aggressive ovarian cancer cells rely on. FAK and EPHA2 are proteins that relay survival signals inside cells. Blocking both at once weakened the cells’ ability to adapt and resist treatment, making them more vulnerable to PARP inhibitors.
Tumours with higher levels of FAK and EPHA2 responded better to the drug combination. Other data link high levels of these molecules to more aggressive disease, pointing to potential benefit in harder-to-treat cases.
Arun Kanakkanthara, an oncology investigator at Mayo Clinic and a senior author of the study, said: “This work shows that drug resistance does not always emerge slowly over time; cancer cells can activate survival programmes very early after treatment begins.”
John Weroha, a medical oncologist at Mayo Clinic and a senior author of the study, said: “From a clinical perspective, resistance remains one of the biggest challenges in treating ovarian cancer. By combining mechanistic insights from Dr Kanakkanthara’s laboratory with my clinical experience, this preclinical work supports the strategy of targeting resistance early, before it has a chance to take hold. This strategy could improve patient outcomes.”
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