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Mind the gap: How menopause affects women disproportionately

Women of colour are more likely to reach menopause earlier and experience more intense symptoms



Many factors come into play when women enter menopause, making each experience unique. Helen Normoyle, co-founder of My Menopause Centre, tells FemTech World why we need a more nuanced understanding of the menopausal transition. 

From the average duration of menopause-related hot flashes to gastrointestinal and vaginal issues, menopause affects women differently.

Recent studies from the Study of Women’s Health Across the Nation (SWAN) have found that women of colour tend to enter perimenopause and menopause at earlier ages than their white peers, have longer transition periods and experience more intense symptoms.

“Raising awareness of menopause across different communities is extremely important,” says Helen Normoyle, co-founder of My Menopause Centre, a website and online menopause clinic.

“We need to be conscious of barriers to diversity and inclusion because changing the mentality around what menopause is and what it is not requires a more nuanced understanding of how cultural differences can shape the way a woman experiences and describes her symptoms.”

My Menopause Centre, led by Dr Clare Spencer, a registered menopause specialist and GP, provides evidence-based and personalised menopause support to women across the UK regardless of their age, health, ethnicity, sexuality or economic background.

The website offers a free online questionnaire that helps women determine whether they are menopausal or perimenopausal and collects information to minimise the existing data gap. The more women complete it, the more they will contribute to the collective understanding of how the menopause is experienced.

“We invested in the questionnaire so that women could use it and get a free personalised assessment,” Normoyle tells me. “We use an algorithm based on all of the thinking that a doctor would use to determine whether or not a woman is in a particular stage of the menopause transition. It doesn’t matter what your friend or your mom did. Every woman’s experience is different.”

The questionnaire is meant to give women more clarity over their symptoms and the support they need and it was inspired by Helen’s personal experience with menopause.

“I was very reluctant to speak about what I was going through,” she remembers. “So, when I decided to talk about it with Claire, who was training to become a menopause specialist, I had a lot of questions.

“After we had a chat, I thought maybe we could bottle up that knowledge and share it with all women because something that happens to every woman isn’t known by every woman. So, we designed the questionnaire to help women better understand the menopausal symptoms and find solutions,” she explains.

“We take a very holistic approach. We look at lifestyle, nutrition, exercise, as well as alternative treatments to HRT, coaching and counselling, but the real driver for it is to help those who can’t afford a private appointment.”

Normoyle and Dr Clare Spencer launched My Menopause Centre in May 2021 and so far more than 15,000 people have filled out the questionnaire. The founders are to meet with MP Carolyn Harris to discuss the findings and inform the government’s current UK Menopause Task Force, to help close the gender data gap and improve the support provided to women.

Menopause is a diversity issue, says Normoyle. “We campaigned on a number of fronts to raise awareness of the impact of menopause and what needs to be done and we submitted evidence into the Department of Health.

“Our findings have shown that the health and data gap is more acute for women of colour and also HRT take-up is significantly lower,” the co-founder continues. “Nobody really understands the reasons behind these differences, but we want to be a key driver in the movement of using evidence and information to close that data gap.”

In March, Channel 4 and My Menopause Centre came together to host a special 4Talks session to discuss the importance of intersectionality when tackling the menopause within the workplace and wider advertising industry, as well as the need to raise awareness of the menopause, treatment options with black and brown women.

“We are very proud of what we’ve done so far,” says Normoyle. “We get patient feedback on a regular basis and when we see the Google reviews coming in, it’s really motivating. That’s the fuel that keeps us going.

“I really hope that with our website and all of our free resources, we can play a role in helping and empowering women to find evidence-based information and advice so that they can take control of their symptoms.”

The clinic is also offering support services to businesses including Tui, VW, Boots, DFS, Hill + Knowlton, Accenture, HSBC, British Airways and Volkswagen, both training staff in menopause awareness and helping menopausal employees.

Normoyle believes that families, societies and companies will all be a better place by having women fully at their best.

“I am fully convinced that by supporting women at this stage of life, we can make the world a better place,” she says. “Menopause shouldn’t be something younger women dread and fear. Knowledge is power and the more prepared you are, the better your experience of menopause will be. I hope we can play a part in reframing that narrative.”

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US virtual care clinic Midi Health to expand in all 50 states

The clinic provides insurance-covered, expert care for women in perimenopause and menopause



The US virtual care clinic Midi Health will expand its services in all 50 states in an effort to help women navigate menopause.

Midi Health aims to provide holistic perimenopause and menopause care and help women navigate the midlife hormonal transition through virtual care.

The company offers personalised care plans and services, including hormonal and non-hormonal medications, supplements, lifestyle coaching and vital preventative health guidance.

Over 6,000 women in the US reach menopause every day, which is defined as starting 12 months after a woman’s last period.

On average, they reach menopause at 51, but perimenopause can occur much earlier. This lead-up period, when hormones can fluctuate wildly and symptoms may be at their worst and most unpredictable, lasts four to seven years, although in some cases it can extend as long as a decade.

Symptoms, which may include hot flashes, insomnia, anxiety, depression, brain fog, memory loss and genitourinary problems, have a significant impact on women’s quality of life and career growth.

“We can’t talk about women’s success at work without talking about menopause,” said Joanna Strober, CEO and co-founder of Midi Health.

“With far too few practitioners trained in managing menopause, women are underdiagnosed, undertreated and underserved.

“Midi provides an insurance-covered solution that focuses on women’s unique needs, closing a major gap in health access, quality and equity.”

She added: “We are expanding rapidly to ensure that we can support employers and employees in all 50 states with Midi’s care.”

The expansion comes weeks after Strober announced a US$25m funding round from Google Ventures (GV) aimed at accelerating partnerships with hospital systems and major US employers, bringing the company’s total funding raised to date to US$40m. 

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Updated menopause toolkit to help doctors provide better care

The toolkit includes new advice and therapies for assessing and treating menopause-related health issues



An updated toolkit that guides health professionals in treating menopause health issues has been published in an effort to improve care for women globally.

Endorsed by the International, Australasian and British Menopause Societies, the Endocrine Society of Australia and Jean Hailes for Women’s Health, the 2023 practitioner’s toolkit for managing the menopause is designed to be used anywhere in the world.  

The toolkit, published originally in 2014, has been updated with new advice and therapies based on a systematic review of the latest menopause research and best practice.

The new version includes bone health guidance, such as recommendations about when menopause hormone therapies might be needed to prevent bone loss and osteoporosis in asymptomatic women.

The update also incorporates new medications including fezolinetant for hot flushes, ospemifene for painful sex, and vaginal DHEA for vaginal dryness.

First author and Monash University women’s health research programme head professor Susan Davis, who also led development of the toolkit in 2014, said the update included some new therapies but did not support menopause hormone therapies for cognitive symptoms or clinical depression.

“Clinical trials have not shown a benefit of menopause hormone therapies for cognitive function,” she explained.

“The most robust studies have shown it to be no better than placebo.”

She added: “Regarding depression, menopause may cause symptoms such as low mood, anxiety, irritability, and mood swings, but clinical depression needs to be assessed and managed in its own right.

“Menopause might exacerbate underlying depression but should not be assumed to be the cause of clinical depression.”

Davis said the advice was now much clearer around preventing bone loss and fracture.

“To our knowledge this is the only document that provides guidance for using hormone therapy to prevent fracture. Other recommendations have been vague such as ‘can be used to prevent bone loss/fracture’ or ‘use to treat osteopenia’.”

The author said it was important for women to see their GP if they experienced troubling physical or mental health symptoms.

“We have updated this as part of an NHMRC Grant to upskill GPs and to embed the care algorithms into GP practice software in the MenoPROMPT study programme, which aims to improve care for women who need it. This is a very important feature of this update.”

Senior author Dr Rakib Islam, from the Monash University School of Public Health and Preventive Medicine women’s health research programme, said the updates would make a difference for many.

“The 2023 practitioner’s toolkit is the most up-to-date evidence-based practical guidance for health care providers to menopause care globally,” he said.

The paper’s authors said the recommendations needed to be applied in the context of local availability and the cost of investigations and drug therapies.

“Most importantly, the toolkit provides the full spectrum of available options and therefore can be used to support shared decision making, and patient-informed care,” they added.

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US fertility benefits provider to introduce perimenopause and menopause support

Patients will be able to have access to specialist health providers trained in menopause and perimenopause care



The US fertility benefits company WIN is to launch a new initiative to help women access perimenopause and menopause support.

The WIN PowerPause programme aims to provide women with perimenopause and menopause support and help patients access specialty care through the virtual menopause clinics Midi Health and Visana Health.

Nurse care advocates will be able to discuss with women perimenopause and menopause symptoms and help them prepare questions to ask their provider during doctor visits. They can also match patients with providers best suited to treat their symptoms.

Patients in all 50 states will have access to providers who are specially trained in menopause and perimenopause care.

WIN says its PowerPause project will also ensure patients have access to behavioural health coaching, nutritional guidance, and prescription medications.

“We are proud to roll out WIN PowerPause to simultaneously address both health and business concerns,” said Roger Shedlin, president and CEO at WIN.

“At WIN, our clients recognise that overlooking menopause care widens the equity gap, given the impact perimenopause and menopause can have on women at a critical time in their careers.

“This is especially true for members in the BIPOC community who tend to experience longer transition periods with more intense symptoms.

“Employers offering comprehensive women’s healthcare to employees is a strategic investment in supporting diverse workforces and fostering a healthier, more productive and engaged team.”

Shelly MacConnell, chief strategy officer at WIN, said: “The population navigating menopause and perimenopause have been underserved, misdiagnosed, or even mistreated due to lack of specialised support and care coordination—until now.

“Through WIN PowerPause and the partnerships with Midi Health and Visana Health, WIN’s goal is to help patients minimise the impact of their symptoms and support them in finding the highest levels of care through seamless coordination.

“This creates a positive patient experience during what can be a stressful and uncertain time in a woman’s life.”

Joe Connolly, co-founder and CEO at Visana Health, added: “We are proud to partner with WIN, a long-standing and trusted fertility benefit company, to provide our patients with access to fertility care and family-building resources.

“This partnership also provides employer partners with the most comprehensive women’s health solution that meets the needs of all women in the workplace, regardless of what stage of life they’re in.”

Joanna Strober, co-founder and CEO of Midi Health, said: “Midi is excited to partner with WIN to expand access to expert-level care for women. Perimenopause and menopause symptoms are treatable, and there is no reason for women to just power through.

“With care protocols created by world-class specialists and a team of highly trained clinicians, Midi’s treatment ensures women are heard and treated appropriately.”

Each year in the U.S., nearly US$1.8bn is lost in work productivity due to menopause symptoms and the associated chronic, yet preventable, conditions, but quality menopause care is hard to find.

Only 1,500 providers worldwide are menopause certified, less than 20 per cent of OB/GYNs receive menopause training, and nearly three-quarters of women report not receiving the necessary treatment for menopause symptoms.

“Menopause is a profound and transformative period in a woman’s life, and it deserves the same level of specialised attention and expertise,” said Dr Lubna Pal, professor of obstetrics, gynaecology and reproductive sciences at Yale School of Medicine and consulting medical director and at WIN.

“Offering dedicated menopause care allows women the knowledge and support they need to navigate this transition in life.”

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