Menopause Medicine Comes of Age: A Founder’s Message

The woman’s health milestone of menopause has finally come of age both socially and medically. Yet, with recognition has come a flood of misinformation, unproven therapies, and misplaced claims of expertise. The Indian Menopause Society (IMS) is to be commended for these state-of-the-science updated Clinical Practice Guidelines (CPG) on Menopause 2026, summarising all we currently know and need to know. My recognition of the “menopause void” was triggered in 1964, when, as a young resident in Johannesburg, I was assigned to review a paper titled “The Fate of the Non-Treated Postmenopausal Woman a Plea for Adequate Estrogen from the Cradle to the Grave.”[1] At that time, menopause in textbooks was defined in a single line: “physiological amenorrhea.” My search for scientific evidence for estrogen’s broader health claims found none, but it sparked a lifelong pursuit. In 1967, with the support of an open-minded mentor, I established the world’s first Menopause Research Clinic at Groote Schuur Hospital, Cape Town.[2] My early studies culminated in the first randomized controlled trial of estrogen therapy (1970), marking the beginning of menopause as a legitimate field of clinical and scientific inquiry.[3] Serendipity came to the fore in April 1973, when I received a letter from one Pieter van Keep, MD, PhD, Director-General of The International Health Foundation (IHF) based in Geneva, Switzerland expressing interest in my early medical publications, telling me of his early social studies on menopause, and inviting my research collaboration. The germinal ideas for much of organized menopause-related medicine had its origin on 1 day in May 1973, over 50 years ago when I met Pieter van Keep. Over a single day of intense discussion, and more than one glass of wine we conceived the idea of a menopause club, later to become the International Menopause Society (IMS), scientific meetings that became the International Menopause Congresses, and a newsletter, later evolving into Maturitas, the first dedicated menopause journal. Our shared conviction was that menopause (my basic and clinical science research approach melded well with Pieter’s psychosocial interests) should be addressed through multidisciplinary collaboration linking biology, psychology, and social science. That belief remains central to the success of IMS, North American Menopause Society (NAMS), and the global menopause movement. By the mid-1970s, we had convened the first International Menopause Congress, and I introduced a standard set of definitions on menopause terminology and worked with the World Health Organization and IMS to further develop this process.[4,5] The STRAW staging system was based on my published modification of the original staging table of van Keep and Kellerhals from the 1970’s.[6] Later, the founding of the NAMS in 1988 furthered our mission of scientific rigor and professional education, leading to the launch of Menopause (journal of NAMS), and the Certified Menopause Practitioner program. For me at least, after almost 60 years of studying the menopause, the wheel has indeed turned full circle. I published in 1969 on the state of the art of postmenopausal hormone therapy at that time.” My conclusion “The possible major disadvantages of long-term therapy on the one hand are a fear of carcinogenesis and thrombogenesis. These risks, if valid, are extremely rare. On the other hand, the possible advantages of long-term therapy are also as yet unproven. Exogenous oestrogens are of undoubted value in the relief of symptoms such as hot flushes, the associated bouts of perspiration, and atrophic vaginitis. Their use in the prevention of coronary arterial disease and the problems of osteoporosis hold definite promise but the results of long-term prospective studies must be awaited before their routine use for the prevention of these disorders can be advocated… an important contribution of the gynecologist would be a more conservative approach to the removal of normal ovaries from the premenopausal female,”[7] remains largely true today. The 2002 termination of the Women’s Health Initiative (WHI) estrogen-progestin arm was a pivotal moment. Amid public confusion, I convened experts through NAMS to publish the first evidence-based position statements on menopausal hormone therapy. These emphasized transparency, conflict-of-interest disclosure, and independence from industry influence – principles that remain vital today. Persistent impediments include misinterpretation of the WHI findings, limited funding for fundamental research, the erosion of public trust, algorithmic rather than individualized care, and pseudo-scientific noise from media voices lacking accountability. Above all, medicine must measure value not merely by risk-benefit ratios but by improvements in women’s quality of life. The IMS CPG 2026 exemplifies these ideals, scientifically grounded, culturally contextual, and ethically transparent. May it empower clinicians to deliver informed, compassionate, and personalized menopause care. For, as Edward Gibbon said, “I have but one lamp by which my feet are guided, and that is the lamp of experience.” That lamp continues to light the path forward toward informed, compassionate, and individualized care for every woman at midlife and beyond.