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.”