Are We Following the Evidence?

It is estimated by 2030, the population of menopausal women in the world will reach 1.2 billion. Menopause-related care is a controversial subject where some suggest too much attention is being given to the over medicalizing of menopause-related care. Others note the large numbers of women experiencing concerns about midlife care and quality of life warrants the need to understand the evidence to effectively guide practice. As nurse researchers and clinicians, we value research and translational science to guide practice, thus it seems wise to reexamine the menopause through this lens. As researchers and clinicians, are we following the most current evidence? Here we discuss this issue, using the Women's Health Initiative (WHI) study as an exemplar (National Heart, Lung, and Blood Institute, 1999). The original WHI study, conducted between 1992 and 2005, included over 68,00 post-menopausal women aged 50–79. The clinical trial examined the role of hormones on chronic diseases in postmenopausal women, most notably cardiovascular disease. In this study, one type of estrogen and progesterone was used. The study was halted due to an increased risk of breast cancer found in one arm of the study (Cagnacci and Venier 2019). This resulted in many providers ceasing or denying hormonal therapy to their patients. In the following 20 years, researchers who have reexamined the WHI data have published findings that highlight the limitations of the WHI study. The study's design and the type and route of hormones used have been scrutinized. Additionally, questions have arisen regarding the age of the participants starting menopausal hormone therapy (MHT) and years removed from the onset of menopause. These are important questions to examine before ceasing all hormonal support considering the potential benefits to women's health. Recent studies examining the role of MHT and women's health have produced positive findings. The Menopause Society position statement holds that for those women who begin MHT within 10 years of menopause and are less than 60 years old with limited risk factors, benefits are favorable for vasomotor symptoms and prevention of bone loss (Faubion et al. 2022). Recent studies also confirm positive benefits such as a decrease in lipids, decreased risk of heart disease and atherosclerosis, and a decreased risk of all-cause mortality (Hodis and Mack 2022). Additional studies examining effects of MHT on the brain and dementia, depression, the musculoskeletal system, metabolic syndrome, biological aging, and genitourinary syndrome of menopause demonstrate positive results in those using MHT. Opponents of treating menopause with the use of MHT seem to have a “status quo” mentality, saying menopause is natural. Providers tell their patients hot flashes only last a couple of years and to just endure them. The problem is that hot flashes can last seven or more years, and they are more than simply an uncomfortable feeling to be endured. Hot flashes are thought to have a relationship with cardiovascular disease, stroke risk, and decreased brain health (Kim et al. 2024). While they may be correct that this is a natural process, does that mean we should ignore evidence and simply endure these symptoms? We are living longer as a society. In past years, women did not have lifespans that greatly outlived ovarian function. It seems a focus on quality of life is as worthy a consideration as quantity of life. The cost of menopause from an economic standpoint is striking. There is an estimated loss of over a billion dollars in economic contribution per year due to work related absences related to menopause symptoms. Search committees are reticent to hire women in the 40–60-year age range due to menopause related changes and the effects on the workforce (Grandey 2022). Undoubtedly, the economic cost is important to contemplate; however, the other aspects of economic loss that impact women should be considered. Being economically sound helps women to provide for themselves and their families. Having economic security enhances women's independence, provides protection against negative socioeconomic factors, and potentially protects women from remaining in difficult situations such as those involving intimate partner violence. Evidence points to the benefits of MHT in certain situations, specifically with women who begin within 10 years of menopause and who are under 60 years old. While this is a very individualized conversation, women should have the opportunity to discuss this with their providers. The World Health Organization (2022) points out that many providers lack adequate training and may not know how to counsel menopausal women to achieve their best health outcomes. This highlights the importance of following the evidence now in the care of midlife women. As researchers and clinicians, we value research, dissemination, and evidence-based practice. Now is the time to follow new evidence instead of research in which many findings have been redacted. It's time that we look at the powerful information that has resulted in the 20 years following the WHI study. As healthcare providers, we should be willing to offer patient centered conversations with midlife women that review individual risk while weighing the positive impact on quality of life and symptom relief. Both authors contributed to the editorial. The authors have nothing to report.