Menopause wars: How much treatment is too much?

Just a few years ago, menopause was unlikely to find its way into the mainstream media. It wasn’t so much a taboo topic, as one that few felt the need to publicly discuss or debate.

For many, including some health professionals, menopause was something most biological women experienced, either medically or naturally, and simply had to push through.

Fast-forward to 2024, and it’s a hot topic.

With more women speaking out about the symptoms some experience, led by 50-something celebrities who have helped raise its profile, menopause is well and truly on the table.

A Senate inquiry is also underway into issues related to menopause and perimenopause.

Medical professionals are navigating their way through a range of treatments, including hormone therapy, and trying to work out when they’re needed, and if so, what is safe and effective.

Recent research in this space has been sparse, with studies mostly of older treatment options, making it hard for those who prescribe and/or need treatment for severely troublesome menopausal symptoms to find a solution.

Exacerbating the confusion is the promotion of testosterone as the “missing hormone” needed to make menopausal hormone therapy complete.

Is testosterone a menopause cure-all?

Our research has shown that approximately one in three postmenopausal Australian women experience low libido, and that for many women, testosterone therapy may be useful for this. Some medical professionals are telling women testosterone will reduce fatigue and improve their energy, while protecting their heart, brain, muscles and bones.

Women are presenting to their GPs to ask about testosterone. Many are having their testosterone blood level tested and told it is “low”. This has been associated with a 10-fold increase in the prescribing of testosterone for women in the UK since 2015.

There are two problems with all of this.

Firstly, “normal blood” testosterone levels in midlife women (women aged 40 to 70 years) are not known, so there’s no level that equates to “low”, which means women can’t be diagnosed as having “low” testosterone.

Secondly, there’s no robust evidence that testosterone will reduce fatigue and improve energy while protecting heart, brain, muscle and bone health, and it’s wrong for women to be told this.

Read more: What are the most common symptoms of menopause? And which can hormone therapy treat?

We’re doing our best to redress this, by establishing what blood levels in midlife women look like, and whether testosterone changes at menopause.

We’re conducting world-first studies to establish whether testosterone benefits bone health and sexual function above the effects of standard HRT (estrogen) in young postmenopausal women (under 55 years), and whether testosterone improves muscle strength in women after the age of 55 using sophisticated testing of muscle strength.

Our Heart Foundation study will show whether testosterone protects heart health in women at high risk of heart disease – women who are overweight, have hypertension, and/or diabetes.

These studies will establish whether testosterone will prevent bone loss (which leads to osteoporosis), protects against loss of muscle mass and function (which affects most women as they age) and heart failure – the most common cause of heart disease in women.

Current guidance on testosterone

The Monash Women’s Health Research program has published the major findings regarding testosterone in women in the past 15 years, and leads the development of the first Global Position Statement on Testosterone for Postmenopausal Women.

Our international menopause toolkit for professionals, which was recently reviewed and updated, is helping medical professionals appropriately treat those who need it.

We’ve also called for a new definition of menopause as “final cessation of ovarian function”, rather than the traditional focus on menstruation.

Among other things, this would encompass those without regular periods before menopause, who used certain types of contraception such as IUDs, and had hysterectomies.

Where to from here?

In order to offer women the best treatments, we need to do high-quality research. This requires women to participate in research studies, because without their participation we cannot give them the answers they seek.

Women interested in participating in our research can visit: monash.edu/medicine/sphpm/units/womenshealth/join-a-study or email women.health@monash.edu.